Provider Demographics
NPI:1639711435
Name:TAMAYO, MARIA ISABEL
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
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:PO BOX 53413
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-3413
Mailing Address - Country:US
Mailing Address - Phone:657-236-1287
Mailing Address - Fax:714-333-4535
Practice Address - Street 1:255 N D ST. SUITE #412, 408
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1735
Practice Address - Country:US
Practice Address - Phone:951-788-5905
Practice Address - Fax:951-788-5903
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1117508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician