Healthcare Provider Details

I. General information

NPI: 1730318254
Provider Name (Legal Business Name): TAMARRAH D OLIVER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 S ELM AVE
FRESNO CA
93706-5435
US

IV. Provider business mailing address

1430 TRUXTUN AVE STE 400
BAKERSFIELD CA
93301-5220
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5200
  • Fax: 559-457-5290
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-326-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: