MEDICARE: TAMRA STAGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	A10960614	CA

General Provider Information

NPI Number	:	1023408408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMRA STAGER

Provider Business Mailing Address
First Line	:	1818 GILBRETH RD STE 230
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-1217
Country	:	US
Telephone Number	:	650-348-6603
Fax Number	:	650-652-2440

Provider Business Practice Location Address
First Line	:	1818 GILBRETH RD STE 230
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-1217
Country	:	US
Telephone Number	:	650-348-6603
Fax Number	:	650-652-2440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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Directions to “ TAMRA STAGER ” Practice Location

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