Provider Demographics
NPI:1144939380
Name:MOIJUEH, TAMMY D (NP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:D
Last Name:MOIJUEH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:D
Other - Last Name:DILLARD-MOIJUEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2229 RIVER PLAZA DR APT 149
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3830
Mailing Address - Country:US
Mailing Address - Phone:925-690-7031
Mailing Address - Fax:
Practice Address - Street 1:2401 W TURNER RD STE 450
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-2191
Practice Address - Country:US
Practice Address - Phone:925-690-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA822172163WC0400X, 163WA0400X, 163WP0808X
CA95027992363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health