Provider Demographics
NPI:1336570597
Name:ELLA-TAMAYO, ROCELY
Entity Type:Individual
Prefix:
First Name:ROCELY
Middle Name:
Last Name:ELLA-TAMAYO
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 1:16136 AVENIDA SAN MIGUEL
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-3454
Mailing Address - Country:US
Mailing Address - Phone:562-947-9197
Mailing Address - Fax:
Practice Address - Street 1:16136 AVENIDA SAN MIGUEL
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-3454
Practice Address - Country:US
Practice Address - Phone:562-947-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine