Individual
TARA LOUISE POWERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1020 29TH ST, SUITE 570B, SACRAMENTO, CA 95816-5125
(916) 453-5955
(916) 733-8250
Mailing address
10470 OLD PLACERVILLE RD, SUITE 100, SACRAMENTO, CA 95827-2539
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
PA18452
CA
207NP0225X
Pediatric Dermatology Physician
PA18452
CA
207NS0135X
Procedural Dermatology Physician
PA18452
CA
363AM0700X
Medical Physician Assistant
PA18452
CA
363AS0400X
Surgical Physician Assistant
Primary
PA18452
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0046090
—
CA
Enumeration date
01/17/2007
Last updated
07/27/2015
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