Individual
SUSANA J TAMAYO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3190 DAVID ST, RIVERSIDE, CA 92506-4250
(714) 272-1601
Mailing address
3190 DAVID ST, RIVERSIDE, CA 92506-4250
(714) 272-1601
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
103K00000X
—
247200000X
Other Technician
Primary
—
CA
Other
Enumeration date
05/02/2018
Last updated
05/02/2018
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