Healthcare Provider Details

I. General information

NPI: 1538246533
Provider Name (Legal Business Name): TAMARA GAIL SANTA ANA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMARA GAIL SANTA ANA DC

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 A SOUTH RANDOLPH STREET
LEXINGTON VA
24450-2432
US

IV. Provider business mailing address

17 A SOUTH RANDOLPH STREET
LEXINGTON VA
24450-2432
US

V. Phone/Fax

Practice location:
  • Phone: 540-463-2462
  • Fax: 540-463-2469
Mailing address:
  • Phone: 540-463-2462
  • Fax: 540-463-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0104001369
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: