MEDICARE: INGA TAMAZOVA

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	251E00000X	Home Health Agency	058101	CA

General Provider Information

NPI Number	:	1891967246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGA TAMAZOVA

Provider Business Mailing Address
First Line	:	4855 SANTA MONICA BLVD
Second Line	:	114
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2654
Country	:	US
Telephone Number	:	323-906-9090
Fax Number	:	323-906-9696

Provider Business Practice Location Address
First Line	:	4855 SANTA MONICA BLVD
Second Line	:	114
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2654
Country	:	US
Telephone Number	:	323-906-9090
Fax Number	:	323-906-9696

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

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	03/26/2008

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Directions to “ INGA TAMAZOVA ” Practice Location

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