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General NPI Number Information
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NPI Number | 1962508903
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Entity Type | Individual
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Provider Name | TARA CODEE MAURO D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 11515 EL CAMINO REAL STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92130-3034
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Country | US
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Telephone | 858-279-1223
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Fax | 858-261-2001
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Provider Business Mailing Address
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Address Line | 11515 EL CAMINO REAL STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92130-3034
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Country | US
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Telephone | 858-279-1223
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Fax | 858-261-2001
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20A16439
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License Number State | CA
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