Healthcare Provider Details

I. General information

NPI: 1467497768
Provider Name (Legal Business Name): PERLITA K TAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 OLIVEHURST AVE
OLIVEHURST CA
95961-4225
US

IV. Provider business mailing address

PO BOX AD
YUBA CITY CA
95992-1396
US

V. Phone/Fax

Practice location:
  • Phone: 530-413-4611
  • Fax: 530-743-5770
Mailing address:
  • Phone: 530-751-3769
  • Fax: 530-751-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD061177L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: