Provider Demographics
NPI:1942358395
Name:TAMBORNINI, GLYNIS G (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:GLYNIS
Middle Name:G
Last Name:TAMBORNINI
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5336
Mailing Address - Country:US
Mailing Address - Phone:707-463-2966
Mailing Address - Fax:707-463-2970
Practice Address - Street 1:756 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5336
Practice Address - Country:US
Practice Address - Phone:707-463-2966
Practice Address - Fax:707-463-2970
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1445237600000X
CAHA2483237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ57005ZOtherBLUE CROSS DIAGNOSTICS
ZZZ57006ZOtherBLUE CROSS DME
ZZZ57006ZOtherBLUE CROSS DME