Domenic Alfonso Tamayo

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

500695639 Issued in OR

Practice address

3515 Kinsrow Ave Apt 406
Eugene, OR 97401-8019

Phone

(541) 726-8198

NPI assigned

Jul 7, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467849600000",
    "number": "1871945352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5542 PRANZ PL",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974021568",
            "telephone_number": "541-513-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 KINSROW AVE APT 406",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974018019",
            "telephone_number": "541-726-8198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAMAYO",
        "first_name": "DOMENIC",
        "middle_name": "ALFONSO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-07",
        "last_updated": "2016-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OR",
            "license": "500695639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500705909",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500695639",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jon William Talebreza-May, LCSW
• Talking Rhythms Massage, LLC
• Melissa Talley
• Tracy Maria Talley
• Hillary Ann Lysak Tamar, MD
• Grace X. Tan, MD
• Andrea Tanaka, LMFT INTERN
• Hannah Tanaka
• Patrick Galvan Tandingan, M.D.
• Sharon Tang, PH.D.

• Community Health Worker in Eugene, OR
• Providers in Eugene, OR by specialty
• Community Health Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.