Provider Demographics
NPI:1891269502
Name:LO, TAMMY EILEEN (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:EILEEN
Last Name:LO
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2141 N HARBOR BLVD STE 25000
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3830
Mailing Address - Country:US
Mailing Address - Phone:714-626-8650
Mailing Address - Fax:714-626-8654
Practice Address - Street 1:2141 N HARBOR BLVD STE 25000
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3830
Practice Address - Country:US
Practice Address - Phone:714-626-8650
Practice Address - Fax:714-626-8654
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA56421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant