Healthcare Provider Details

I. General information

NPI: 1851643712
Provider Name (Legal Business Name): TAMARA L. OBREGON MADERA PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N INDIAN HILL BLVD STE 202A
CLAREMONT CA
91711-4644
US

IV. Provider business mailing address

219 N INDIAN HILL BLVD STE 202A
CLAREMONT CA
91711-4644
US

V. Phone/Fax

Practice location:
  • Phone: 626-386-3036
  • Fax:
Mailing address:
  • Phone: 626-386-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: