Provider Demographics
NPI:1215916135
Name:KUROIWA, TARA NICOLE (PAC)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:NICOLE
Last Name:KUROIWA
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Gender:F
Credentials:PAC
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Mailing Address - Street 1:15425 LOS GATOS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2553
Mailing Address - Country:US
Mailing Address - Phone:408-358-1911
Mailing Address - Fax:408-358-3430
Practice Address - Street 1:15425 LOS GATOS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2553
Practice Address - Country:US
Practice Address - Phone:408-358-1911
Practice Address - Fax:408-358-3430
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA18094363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant