Provider Demographics
NPI:1972125508
Name:TAMAYO, MARIANA (AP4154)
Entity type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:AP4154
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 26TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-7057
Mailing Address - Country:US
Mailing Address - Phone:941-565-9904
Mailing Address - Fax:
Practice Address - Street 1:1109 26TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-7057
Practice Address - Country:US
Practice Address - Phone:941-565-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist