Healthcare Provider Details

I. General information

NPI: 1518882497
Provider Name (Legal Business Name): GLADYS NICOLE TAMAYO-QUERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SANTA BARBARA ST STE B
SANTA PAULA CA
93060-2675
US

IV. Provider business mailing address

3390 RIDDEN ST
CAMARILLO CA
93010-3840
US

V. Phone/Fax

Practice location:
  • Phone: 805-250-7505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: