Healthcare Provider Details

I. General information

NPI: 1215207709
Provider Name (Legal Business Name): TAMARA M PRAUS CMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 LINCOLN CTR
STOCKTON CA
95207-2642
US

IV. Provider business mailing address

633 LINCOLN CTR
STOCKTON CA
95207-2642
US

V. Phone/Fax

Practice location:
  • Phone: 209-298-8756
  • Fax:
Mailing address:
  • Phone: 209-298-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26328
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: