Healthcare Provider Details

I. General information

NPI: 1013698919
Provider Name (Legal Business Name): TAMAR TAMARASHVILI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 E WASHINGTON BLVD
CRESCENT CITY CA
95531-8397
US

IV. Provider business mailing address

5051 LAKE EARL DR
CRESCENT CITY CA
95531-9738
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-6715
  • Fax:
Mailing address:
  • Phone: 707-464-6715
  • Fax: 707-465-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA207399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: