Provider Demographics
NPI:1689926123
Name:ANDERSON, TAMARA V
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:V
Last Name:ANDERSON
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 1:31 PANORAMIC WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1627
Mailing Address - Country:US
Mailing Address - Phone:925-938-8686
Mailing Address - Fax:925-938-7473
Practice Address - Street 1:31 PANORAMIC WAY FL 1
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1627
Practice Address - Country:US
Practice Address - Phone:925-938-8686
Practice Address - Fax:925-938-7473
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist