Healthcare Provider Details

I. General information

NPI: 1336079490
Provider Name (Legal Business Name): TAMMIRA MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15446 BROOKHURST ST
WESTMINSTER CA
92683-7057
US

IV. Provider business mailing address

15446 BROOKHURST ST
WESTMINSTER CA
92683-7057
US

V. Phone/Fax

Practice location:
  • Phone: 213-632-8055
  • Fax:
Mailing address:
  • Phone: 213-632-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: STACI DAO
Title or Position: COO
Credential:
Phone: 213-632-8055