Provider Demographics
NPI:1801128368
Name:TAMARA T. KURMANALIEVA, PC
Entity type:Organization
Organization Name:TAMARA T. KURMANALIEVA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:T
Authorized Official - Last Name:KURMANALIEVA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:949-387-8422
Mailing Address - Street 1:4920 BARRANCA PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4672
Mailing Address - Country:US
Mailing Address - Phone:949-387-8422
Mailing Address - Fax:949-387-8423
Practice Address - Street 1:4920 BARRANCA PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4672
Practice Address - Country:US
Practice Address - Phone:949-387-8422
Practice Address - Fax:949-387-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0UW892, 0844892OtherBLUE CROSS/BLUE CROSS SENIOR
144535OtherHEALTH NET/HEALTH NET SENIOR
426431OtherAETNA/AETNA SENIOR
7G0847/8U0694/L80885OtherBLUE SHIELD 65 PLUS
0219630488OtherSECURE HORIZONS
091808OtherSCAN
00A985040OtherONECARE
0149050651OtherPACIFICARE
7261810002OtherCIGNA
00A985040OtherCALOPTIMA
CA00A985040Medicaid
00985040OtherBLUE SHIELD
0022776230002OtherGREAT WEST
7261810002OtherCIGNA
CA00A985040Medicaid