Provider Demographics
NPI:1972718096
Name:TAYAMA, TRICIA MICHELS (MD)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:MICHELS
Last Name:TAYAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:MICHELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:380 90TH ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1807
Mailing Address - Country:US
Mailing Address - Phone:650-301-8769
Mailing Address - Fax:650-301-8626
Practice Address - Street 1:380 90TH ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1807
Practice Address - Country:US
Practice Address - Phone:650-301-8769
Practice Address - Fax:650-301-8626
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN