Provider Demographics
NPI:1598750473
Name:MAHER, TAMARA Z (DO)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:Z
Last Name:MAHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10861 CHERRY ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5402
Mailing Address - Country:US
Mailing Address - Phone:562-431-9200
Mailing Address - Fax:562-431-9232
Practice Address - Street 1:10861 CHERRY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5402
Practice Address - Country:US
Practice Address - Phone:562-431-9200
Practice Address - Fax:562-431-9232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-17
Provider Licenses
StateLicense IDTaxonomies
CA20A6084207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6084OtherSTATE LICENSE
CAF57124Medicare UPIN
CA20A6084OtherSTATE LICENSE