Healthcare Provider Details

I. General information

NPI: 1841654936
Provider Name (Legal Business Name): TAMARA M VAHALIK MS ED, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 PEPPER DR
EL CAJON CA
92021-1205
US

IV. Provider business mailing address

977 PEPPER DR
EL CAJON CA
92021-1205
US

V. Phone/Fax

Practice location:
  • Phone: 619-277-6239
  • Fax:
Mailing address:
  • Phone: 619-277-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: