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General NPI Number Information
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NPI Number | 1588951263
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Entity Type | Individual
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Provider Name | MAYLYNN LILY TAM-MCSORLEY DPM
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Gender | Female
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 270 INTERNATIONAL CIR
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City | SAN JOSE
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State | CA
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Zip | 95119-1130
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Country | US
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Telephone | 408-362-4341
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Fax |
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Provider Business Mailing Address
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Address Line | 975 SERENO DR
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City | VALLEJO
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State | CA
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Zip | 94589-2441
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5114
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License Number State | CA
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