Provider Demographics
NPI:1851456354
Name:KELLEY, TAMARA
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:KELLEY
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 1:31150 TEMECULA PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2916
Mailing Address - Country:US
Mailing Address - Phone:951-692-4660
Mailing Address - Fax:951-302-6895
Practice Address - Street 1:31150 TEMECULA PKWY
Practice Address - Street 2:STE 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2916
Practice Address - Country:US
Practice Address - Phone:951-692-4660
Practice Address - Fax:951-302-6895
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC137498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine