Provider Demographics
NPI:1215332572
Name:BRAJOVIC, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:BRAJOVIC
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 1:4224 ARCATA WAY STE A
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3381
Mailing Address - Country:US
Mailing Address - Phone:702-630-2717
Mailing Address - Fax:
Practice Address - Street 1:4224 ARCATA WAY STE A
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3381
Practice Address - Country:US
Practice Address - Phone:702-630-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker