Individual
MS. TAMARA DEE THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IDC
Contact information
Practice address
1128 EMORY ST, IMPERIAL BEACH, CA 91932-3324
(619) 948-5154
Mailing address
1128 EMORY ST, IMPERIAL BEACH, CA 91932-3324
(619) 948-5154
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9068
IDC
—
Enumeration date
02/18/2011
Last updated
02/18/2011
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