Provider Demographics
NPI:1912784505
Name:BISSESAR, TAMARA (MA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:BISSESAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 SW GALLOWAY CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8132
Mailing Address - Country:US
Mailing Address - Phone:773-431-5958
Mailing Address - Fax:
Practice Address - Street 1:6443 SW BEAVERTON HILLSDALE HWY FL 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1164
Practice Address - Country:US
Practice Address - Phone:503-542-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program