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General NPI Number Information
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NPI Number | 1801605035
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Entity Type | Organization
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Legal Business Name | TAMAR-MATTIS, D.O., A PROFESSIONAL ORGANIZATION
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 1020 GRAVENSTEIN HWY S STE 120
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4863
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Country | US
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Telephone | 707-861-0807
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 GRAVENSTEIN HWY S STE 120
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4863
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Country | US
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Telephone | 707-861-0807
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINSITRATIVE OFFICER
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Name | ANNE TAMAR-MATTIS
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Credential |
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Telephone | 707-861-0807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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