Provider Demographics
NPI:1982691374
Name:FERNANDEZ, TAMARA L (ATC, LMT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 HELM DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3809
Mailing Address - Country:US
Mailing Address - Phone:702-334-5504
Mailing Address - Fax:
Practice Address - Street 1:1551 HELM DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3809
Practice Address - Country:US
Practice Address - Phone:702-334-5504
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05060232255A2300X
NY013980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist