# MAA TARA LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598554396
- **Authorized official:** KAMILLA ARCHUNDIA CPT (DIRECTOR/CEO)
- **Authorized official phone:** (951) 472-8077

## Contact information

- **Practice address:** 4469 N BROADMOOR AVE, COVINA, CA 91722-2201
- **Practice address phone:** (951) 472-8077
- **Mailing address:** 200 E ROWLAND ST UNIT 2104, COVINA, CA 91723-3146
- **Mailing address phone:** (951) 472-8077

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246QL0900X | Laboratory Management Specialist/Technologist | — | NULL | — |
| 246QL0900X | Laboratory Management Specialist/Technologist | — | — | — |
| 246RP1900X | Phlebotomy Technician | — | NULL | — |
| 246RP1900X | Phlebotomy Technician | — | — | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 05/06/2025
- **Last updated:** 05/06/2025