Provider Demographics
NPI:1871629410
Name:BETTILYON, TAMYRA J
Entity Type:Individual
Prefix:
First Name:TAMYRA
Middle Name:J
Last Name:BETTILYON
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 1:13737 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-3431
Mailing Address - Country:US
Mailing Address - Phone:858-486-2642
Mailing Address - Fax:
Practice Address - Street 1:13737 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-3431
Practice Address - Country:US
Practice Address - Phone:858-486-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker