Healthcare Provider Details

I. General information

NPI: 1144176777
Provider Name (Legal Business Name): ALFONZO W TUCKER ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7181 W DOVEWOOD LN
FRESNO CA
93723-4044
US

IV. Provider business mailing address

6569 N RIVERSIDE DR STE 102
FRESNO CA
93722-9319
US

V. Phone/Fax

Practice location:
  • Phone: 925-858-6911
  • Fax:
Mailing address:
  • Phone: 925-858-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: