Healthcare Provider Details

I. General information

NPI: 1740900315
Provider Name (Legal Business Name): TIANJIAO CUI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 N MARIPOSA LN
DUBLIN CA
94568-2567
US

IV. Provider business mailing address

6965 N MARIPOSA LN
DUBLIN CA
94568-2567
US

V. Phone/Fax

Practice location:
  • Phone: 415-601-9084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95022038
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86068082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: