1396864997 NPI number — DR. TAMARA J KLUMPE PHD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396864997 NPI number — DR. TAMARA J KLUMPE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLUMPE
Provider First Name:
TAMARA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHERAN
Provider Other First Name:
TAMARA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396864997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1809 VERDUGO BLVD
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91208-1418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-952-2730
Provider Business Mailing Address Fax Number:
818-790-0219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 VERDUGO BLVD
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91208-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-952-2730
Provider Business Practice Location Address Fax Number:
818-790-0219
Provider Enumeration Date:
03/28/2007

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: 103T00000X , with the licence number:  PSY4106 , 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)

  • Identifier: 133067 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".




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