Individual
TAM DO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2900 BRISTOL ST STE B205, COSTA MESA, CA 92626-5948
(949) 274-4323
(949) 274-4323
Mailing address
18111 BROOKHURST ST STE 5400, FOUNTAIN VALLEY, CA 92708-6728
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95017595
CA
363LF0000X
Family Nurse Practitioner
95017595
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95017595
CA
Other
Enumeration date
01/25/2020
Last updated
04/05/2025
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