Provider Demographics
NPI:1174806715
Name:NAZARIO, TAMMY LYNN
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 LAKE AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2491
Mailing Address - Country:US
Mailing Address - Phone:626-797-9196
Mailing Address - Fax:
Practice Address - Street 1:2235 LAKE AVE STE 211
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2491
Practice Address - Country:US
Practice Address - Phone:626-797-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131698106H00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist