MEDICARE: TAMARA ITO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1194688812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA ITO

Provider Business Mailing Address
First Line	:	713 LINWOOD ST
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-3524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 HOSPITAL DR STE 110
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94589-2577
Country	:	US
Telephone Number	:	707-551-3300
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ TAMARA ITO ” Practice Location

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