Provider Demographics
NPI:1275030157
Name:MCINTOSH, TAMRA
Entity Type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAMRA
Other - Middle Name:
Other - Last Name:LAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2960 HOLDREGE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1800
Mailing Address - Country:US
Mailing Address - Phone:916-956-2738
Mailing Address - Fax:
Practice Address - Street 1:180 PROMENADE CIR STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2952
Practice Address - Country:US
Practice Address - Phone:916-299-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1025413343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)