Organization
MAA TARA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMILLA ARCHUNDIA CPT (DIRECTOR/CEO)
(951) 472-8077
Entity
Organization
Contact information
Practice address
4469 N BROADMOOR AVE, COVINA, CA 91722-2201
(951) 472-8077
Mailing address
200 E ROWLAND ST UNIT 2104, COVINA, CA 91723-3146
(951) 472-8077
Taxonomy
Speciality
Code
Description
License number
State
246QL0900X
Laboratory Management Specialist/Technologist
—
—
246RP1900X
Phlebotomy Technician
—
—
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
05/06/2025
Last updated
05/06/2025
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