Provider Demographics
NPI:1912945445
Name:TAMUPOVI, SANDORA TAUZ (LMT)
Entity Type:Individual
Prefix:MS
First Name:SANDORA
Middle Name:TAUZ
Last Name:TAMUPOVI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 5 BOX 308A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-2642
Mailing Address - Country:US
Mailing Address - Phone:505-579-4242
Mailing Address - Fax:
Practice Address - Street 1:705 LA JOYA ST STE A
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2233
Practice Address - Country:US
Practice Address - Phone:505-690-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5228171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor