MEDICARE: TAMARA L FERNANDEZ ATC, LMT

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	2255A2300X	Athletic Trainer	0506023	NV
2	225700000X	Massage Therapist	013980	NY

General Provider Information

NPI Number	:	1982691374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA L FERNANDEZ ATC, LMT

Provider Business Mailing Address
First Line	:	1551 HELM DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3809
Country	:	US
Telephone Number	:	702-334-5504
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 HELM DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3809
Country	:	US
Telephone Number	:	702-334-5504
Fax Number	:

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	09/11/2025

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