Provider Demographics
NPI:1194333427
Name:LANGEVAIN, TAMARA RAQUEL (RADT/ MHRT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:RAQUEL
Last Name:LANGEVAIN
Suffix:
Gender:F
Credentials:RADT/ MHRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14038 CHOCO RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5526
Mailing Address - Country:US
Mailing Address - Phone:760-927-8662
Mailing Address - Fax:
Practice Address - Street 1:14038 CHOCO RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-5526
Practice Address - Country:US
Practice Address - Phone:760-927-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider