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Individual

DOMENIC ALFONSO TAMAYO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3515 KINSROW AVE APT 406, EUGENE, OR 97401-8019
(541) 726-8198
Mailing address
5542 PRANZ PL, EUGENE, OR 97402-1568
(541) 513-5489

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
500695639
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500695639
OR
05
500705909
OR
Enumeration date
07/07/2016
Last updated
07/07/2016
About Stedi
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  • EDI platform