Healthcare Provider Details

I. General information

NPI: 1619390614
Provider Name (Legal Business Name): TAMAR ROSNER DAVIDSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26012 MARGUERITE PKWY STE H
MISSION VIEJO CA
92692-3263
US

IV. Provider business mailing address

26012 MARGUERITE PKWY STE H
MISSION VIEJO CA
92692-3263
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: