Healthcare Provider Details

I. General information

NPI: 1053248609
Provider Name (Legal Business Name): TINY THOMAS NALUMAKKIYIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15610 SAINT CLEMENT WAY
BAKERSFIELD CA
93314-6742
US

IV. Provider business mailing address

15610 SAINT CLEMENT WAY
BAKERSFIELD CA
93314-6742
US

V. Phone/Fax

Practice location:
  • Phone: 818-319-6818
  • Fax:
Mailing address:
  • Phone: 818-319-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number95039313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: