Provider Demographics
NPI:1922350255
Name:MARCHIDO, TARA (NP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MARCHIDO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7474 ELM GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9066
Mailing Address - Country:US
Mailing Address - Phone:951-279-9175
Mailing Address - Fax:
Practice Address - Street 1:3050 REGENT BLVD
Practice Address - Street 2:SUITE100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3196
Practice Address - Country:US
Practice Address - Phone:214-689-3600
Practice Address - Fax:214-689-3644
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14202363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology