Healthcare Provider Details

I. General information

NPI: 1457584898
Provider Name (Legal Business Name): THE TAM PACIFIC GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SHORELINE HWY SUITE B28
MILL VALLEY CA
94941-3639
US

IV. Provider business mailing address

150 SHORELINE HWY SUITE B28
MILL VALLEY CA
94941-3639
US

V. Phone/Fax

Practice location:
  • Phone: 415-332-3300
  • Fax: 415-373-9449
Mailing address:
  • Phone: 415-332-3300
  • Fax: 415-373-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL WICHMAN
Title or Position: PRESIDENT
Credential:
Phone: 415-332-3300