Provider Demographics
NPI:1023408408
Name:STAGER, TAMRA
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:STAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 GILBRETH RD STE 230
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1217
Mailing Address - Country:US
Mailing Address - Phone:650-348-6603
Mailing Address - Fax:650-652-2440
Practice Address - Street 1:1818 GILBRETH RD STE 230
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1217
Practice Address - Country:US
Practice Address - Phone:650-348-6603
Practice Address - Fax:650-652-2440
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA10960614101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)