Provider Demographics
NPI:1801605035
Name:TAMAR-MATTIS, D.O., A PROFESSIONAL ORGANIZATION
Entity type:Organization
Organization Name:TAMAR-MATTIS, D.O., A PROFESSIONAL ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINSITRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMAR-MATTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-861-0807
Mailing Address - Street 1:1020 GRAVENSTEIN HWY S STE 120
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4863
Mailing Address - Country:US
Mailing Address - Phone:707-861-0807
Mailing Address - Fax:
Practice Address - Street 1:1020 GRAVENSTEIN HWY S STE 120
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4863
Practice Address - Country:US
Practice Address - Phone:707-861-0807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty