Provider Demographics
NPI:1811762560
Name:MABANAG, TAMRA (PCD(DONA), PMH-C)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:MABANAG
Suffix:
Gender:F
Credentials:PCD(DONA), PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 CAHALAN AVE # 23508
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3008
Mailing Address - Country:US
Mailing Address - Phone:408-892-9035
Mailing Address - Fax:
Practice Address - Street 1:6126 HEATHERCREEK WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-4724
Practice Address - Country:US
Practice Address - Phone:408-892-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula