Provider Demographics
NPI:1831885920
Name:TAMAYO, JEREMY LEE
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:LEE
Last Name:TAMAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18444 PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2112
Mailing Address - Country:US
Mailing Address - Phone:818-349-6267
Mailing Address - Fax:818-349-1557
Practice Address - Street 1:18444 PLUMMER ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-2112
Practice Address - Country:US
Practice Address - Phone:818-349-6267
Practice Address - Fax:818-349-1557
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172388183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician