Provider Demographics
NPI:1912379967
Name:TAMAYO-HARVEY, PATRICK
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:TAMAYO-HARVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCABA
Mailing Address - Street 1:785 GRAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2370
Mailing Address - Country:US
Mailing Address - Phone:760-720-4964
Mailing Address - Fax:
Practice Address - Street 1:785 GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2370
Practice Address - Country:US
Practice Address - Phone:760-720-4964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-15-6697OtherBCABA