Healthcare Provider Details

I. General information

NPI: 1386989994
Provider Name (Legal Business Name): MR. RALPH TAMAYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 N RAMPART ST
ORANGE CA
92868-1852
US

IV. Provider business mailing address

11966 ASHWORTH ST
ARTESIA CA
90701-4138
US

V. Phone/Fax

Practice location:
  • Phone: 714-939-9300
  • Fax:
Mailing address:
  • Phone: 562-215-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: