Basic Information
| Provider Information | |||||||||
| NPI: | 1841332947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELLO | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 516 N KAWEAH AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932211200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595944969 | ||||||||
| FaxNumber: | 5595944308 | ||||||||
| Practice Location | |||||||||
| Address1: | 516 N KAWEAH AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932211200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595944969 | ||||||||
| FaxNumber: | 5595944308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT27854 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.