Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | PA18740 | CA |
NPI | 1871624155 |
---|---|
Provider Name | Andrew Takashi Tamura |
First Address | Upland, CA 91786-5182 |
Second Address | Upland, CA 91786-5182 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 01/12/2021 |