Healthcare Provider Details

I. General information

NPI: 1972718096
Provider Name (Legal Business Name): TRICIA MICHELS TAYAMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRICIA MICHELS MD

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 90TH ST
DALY CITY CA
94015-1807
US

IV. Provider business mailing address

380 90TH ST
DALY CITY CA
94015-1807
US

V. Phone/Fax

Practice location:
  • Phone: 650-301-8769
  • Fax: 650-301-8626
Mailing address:
  • Phone: 650-301-8769
  • Fax: 650-301-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: