Healthcare Provider Details

I. General information

NPI: 1316177868
Provider Name (Legal Business Name): TISHA SINCLAIR RDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 MING AVE
BAKERSFIELD CA
93304-4139
US

IV. Provider business mailing address

3216 MING AVE
BAKERSFIELD CA
93304-4139
US

V. Phone/Fax

Practice location:
  • Phone: 661-834-0400
  • Fax: 661-834-0406
Mailing address:
  • Phone: 661-834-0400
  • Fax: 661-834-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number5677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: