Healthcare Provider Details

I. General information

NPI: 1881517647
Provider Name (Legal Business Name): CAMERON TUCKER CHW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SPECTRUM CENTER DR STE 400
IRVINE CA
92618-4989
US

IV. Provider business mailing address

300 SPECTRUM CENTER DR STE 400
IRVINE CA
92618-4989
US

V. Phone/Fax

Practice location:
  • Phone: 949-299-2023
  • Fax:
Mailing address:
  • Phone: 949-299-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: