Provider Demographics
NPI:1588212195
Name:DENGA, TAMARRIA
Entity Type:Individual
Prefix:
First Name:TAMARRIA
Middle Name:
Last Name:DENGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 N 31ST AVE STE D411
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1358
Mailing Address - Country:US
Mailing Address - Phone:602-612-4410
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE STE D411
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1358
Practice Address - Country:US
Practice Address - Phone:602-612-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health