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General NPI Number Information
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NPI Number | 1689970741
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Entity Type | Individual
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Provider Name | TAMARA HARBISON C. PED
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Gender | Female
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 9737 GREAT HILLS TRL SUITE 240
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City | AUSTIN
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State | TX
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Zip | 78759-6417
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Country | US
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Telephone | 512-626-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 1224 COMMERCE CT SUITE 6
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City | LAFAYETTE
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State | CO
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Zip | 80026-2464
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Country | US
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Telephone | 303-666-5889
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Fax | 303-666-7991
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 2794
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License Number State | DE
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