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General NPI Number Information
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NPI Number | 1578645669
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Entity Type | Individual
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Provider Name | TAMARA LIVINGSTON M.A.
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5675 RUFFIN ROAD SUITE325
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 858-467-9170
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Fax |
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Provider Business Mailing Address
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Address Line | 16561 VIA LAGO AZUL PO BOX 8403
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City | RANCHO SANTA FE
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State | CA
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Zip | 92067-8403
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Country | US
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Telephone | 959-756-3269
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 43353
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License Number State | CA
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