Provider Demographics
NPI:1215093794
Name:TAM, EISEL AQUINO (NP)
Entity type:Individual
Prefix:
First Name:EISEL
Middle Name:AQUINO
Last Name:TAM
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:39150 PASEO PADRE PKWY
Mailing Address - Street 2:203
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1612
Mailing Address - Country:US
Mailing Address - Phone:510-505-1091
Mailing Address - Fax:510-505-1111
Practice Address - Street 1:1900 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2200
Practice Address - Country:US
Practice Address - Phone:650-991-6304
Practice Address - Fax:650-991-6540
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP13561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP13561OtherSTATE LICENSE NUMBER
CANP13561OtherSTATE LICENSE NUMBER