Healthcare Provider Details

I. General information

NPI: 1336073618
Provider Name (Legal Business Name): TAMARA LOUISE CONNORS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 HERMITAGE AVE APT 3
VALLEY VILLAGE CA
91607-2554
US

IV. Provider business mailing address

5252 HERMITAGE AVE APT 3
VALLEY VILLAGE CA
91607-2554
US

V. Phone/Fax

Practice location:
  • Phone: 818-859-4928
  • Fax:
Mailing address:
  • Phone: 818-859-4928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW135146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: