MEDICARE: TAMARA S. ENFIEDJIAN D.P.T.

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	225100000X	Physical Therapist	PT33394	CA

General Provider Information

NPI Number	:	1588711105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA S. ENFIEDJIAN D.P.T.

Provider Business Mailing Address
First Line	:	1845 BUSINESS CENTER DR STE 127
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3434
Country	:	US
Telephone Number	:	909-890-9030
Fax Number	:	909-890-4393

Provider Business Practice Location Address
First Line	:	100 N BARRANCA ST STE 380
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-1637
Country	:	US
Telephone Number	:	626-331-8355
Fax Number	:	909-890-4393

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	02/28/2022

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