Provider Demographics
NPI:1952346785
Name:CHAMBLESS, TAMARA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:ANN
Last Name:CHAMBLESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 S LEMON ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4626
Mailing Address - Country:US
Mailing Address - Phone:720-256-5384
Mailing Address - Fax:
Practice Address - Street 1:10850 GOLD CENTER DR STE 325
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-567-4222
Practice Address - Fax:916-567-4220
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43903174400000X
CODR.00439032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25223861Medicaid
CO25223861Medicaid