Provider Demographics
NPI:1215256755
Name:TAMAYO, KARINA
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 SAMARITAN DR STE 715
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4103
Mailing Address - Country:US
Mailing Address - Phone:408-962-9267
Mailing Address - Fax:408-402-3719
Practice Address - Street 1:2577 SAMARITAN DR STE 715
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4103
Practice Address - Country:US
Practice Address - Phone:408-962-9267
Practice Address - Fax:408-402-3719
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist