Healthcare Provider Details

I. General information

NPI: 1801128368
Provider Name (Legal Business Name): TAMARA T. KURMANALIEVA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 BARRANCA PKWY SUITE D
IRVINE CA
92604-4672
US

IV. Provider business mailing address

4920 BARRANCA PKWY SUITE D
IRVINE CA
92604-4672
US

V. Phone/Fax

Practice location:
  • Phone: 949-387-8422
  • Fax: 949-387-8423
Mailing address:
  • Phone: 949-387-8422
  • Fax: 949-387-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA98504
License Number StateCA

VIII. Authorized Official

Name: DR. TAMARA T. KURMANALIEVA
Title or Position: PRESIDENT
Credential: M. D.
Phone: 949-387-8422