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NPI Code Detail

MEDICARE: MRS. TAMARA RIDGE MS LMFT

MEDICARE: MRS. TAMARA RIDGE MS LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC37840CA

General Provider Information

NPI Number : 1801963467
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAMARA RIDGE MS LMFT
Provider Business Mailing Address
First Line : 19070 STODDARD WAY
Second Line :
City : APPLE VALLEY
State : CA
Zip : 92308-4975
Country : US
Telephone Number : 323-430-0702
Fax Number :
Provider Business Practice Location Address
First Line : 680 E. COLORADO BLVD
Second Line : SUITE 180 & SECOND FLOOR
City : PASADENA
State : CA
Zip : 91101-6143
Country : US
Telephone Number : 626-657-0061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 04/06/2020

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