Provider Demographics
NPI:1699586149
Name:SIBALA, TAMARA (BSN, RN, PHN, CPN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SIBALA
Suffix:
Gender:F
Credentials:BSN, RN, PHN, CPN
Other - Prefix:
Other - First Name:MARIA TAMARA
Other - Middle Name:AGUILAR
Other - Last Name:SIBALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:338 S DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:VANDENBERG AFB
Mailing Address - State:CA
Mailing Address - Zip Code:93437-6307
Mailing Address - Country:US
Mailing Address - Phone:805-605-2657
Mailing Address - Fax:805-606-4381
Practice Address - Street 1:338 S DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:VANDENBERG AFB
Practice Address - State:CA
Practice Address - Zip Code:93437-6307
Practice Address - Country:US
Practice Address - Phone:805-605-2657
Practice Address - Fax:805-606-4381
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA711961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty