Provider Demographics
NPI:1598231490
Name:TAMAYO, MARIAH LACEL
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:LACEL
Last Name:TAMAYO
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 1:13230 JOHANNESBERG WAY UNIT 11
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4761
Mailing Address - Country:US
Mailing Address - Phone:858-333-1330
Mailing Address - Fax:
Practice Address - Street 1:15708 POMERADO RD STE 102
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2035
Practice Address - Country:US
Practice Address - Phone:858-746-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst