Healthcare Provider Details

I. General information

NPI: 1437255429
Provider Name (Legal Business Name): TAMMY LYNN OLMSTEAD P.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

2100 POWELL ST STE 900
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4111
  • Fax:
Mailing address:
  • Phone: 510-350-2600
  • Fax: 510-879-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: