1013108364 NPI number — MS. TAMARA LOUISE KIRBY LVN

Table of content: MS. TAMARA LOUISE KIRBY LVN (NPI 1013108364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013108364 NPI number — MS. TAMARA LOUISE KIRBY LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRBY
Provider First Name:
TAMARA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LVN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
TAMARA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LVN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013108364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 W MISSION AVE
Provider Second Line Business Mailing Address:
103
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92025-1720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-747-3424
Provider Business Mailing Address Fax Number:
760-747-3435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 W MISSION AVE
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-747-3424
Provider Business Practice Location Address Fax Number:
760-747-3435
Provider Enumeration Date:
08/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164X00000X , with the licence number:  VN119769 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)