Provider Demographics
NPI:1972607331
Name:DIAZ, TAMARA LYN (DC, CCEP)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5631
Mailing Address - Country:US
Mailing Address - Phone:408-267-7649
Mailing Address - Fax:
Practice Address - Street 1:1836 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5631
Practice Address - Country:US
Practice Address - Phone:408-267-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor