Provider Demographics
NPI:1871864587
Name:TAMAYO-ORTEGA, DEBBIE ANGELA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:ANGELA
Last Name:TAMAYO-ORTEGA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 RIDGEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1367
Mailing Address - Country:US
Mailing Address - Phone:909-256-4447
Mailing Address - Fax:
Practice Address - Street 1:9052 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1621
Practice Address - Country:US
Practice Address - Phone:909-624-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH40874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist