Individual
ANDREW TAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
755 W HOFFER ST, BANNING, CA 92220-2348
(951) 922-0356
Mailing address
9594 AMERICAN WAY, MORENO VALLEY, CA 92557-3559
(619) 306-2828
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/29/2019
Last updated
05/16/2022
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