Healthcare Provider Details

I. General information

NPI: 1518947779
Provider Name (Legal Business Name): TAM CONG DAO PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 NAPLES ST
CHULA VISTA CA
91911-1636
US

IV. Provider business mailing address

3287 RANCHO DIEGO CIR
EL CAJON CA
92019-5124
US

V. Phone/Fax

Practice location:
  • Phone: 619-585-5540
  • Fax: 619-427-7910
Mailing address:
  • Phone: 619-669-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH49801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: