Provider Demographics
NPI:1134595614
Name:BAUDIZZON, TAMMERAB
Entity type:Individual
Prefix:
First Name:TAMMERAB
Middle Name:
Last Name:BAUDIZZON
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:PO BOX 158
Mailing Address - Street 2:333 TOM BELL RD
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093-0158
Mailing Address - Country:US
Mailing Address - Phone:530-623-1204
Mailing Address - Fax:530-623-1237
Practice Address - Street 1:51 INDUSTRIAL WAY
Practice Address - Street 2:333 TOM BELL RD
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093
Practice Address - Country:US
Practice Address - Phone:530-623-1204
Practice Address - Fax:530-623-1237
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3315806OtherDRIVERS LICENSE