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General NPI Number Information
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NPI Number | 1023228566
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Entity Type | Individual
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Provider Name | TAMARA KATE FANCHER PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 303 W LINCOLN AVE STE 105
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City | ANAHEIM
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State | CA
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Zip | 92805-2928
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Country | US
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Telephone | 714-922-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 31103 RANCHO VIEJO RD STE D3029
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1759
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 18358
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License Number State | CA
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