Healthcare Provider Details

I. General information

NPI: 1982691374
Provider Name (Legal Business Name): TAMARA L FERNANDEZ ATC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 HELM DR
LAS VEGAS NV
89119-3809
US

IV. Provider business mailing address

1551 HELM DR
LAS VEGAS NV
89119-3809
US

V. Phone/Fax

Practice location:
  • Phone: 702-334-5504
  • Fax:
Mailing address:
  • Phone: 702-334-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0506023
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number013980
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: