Healthcare Provider Details

I. General information

NPI: 1386804581
Provider Name (Legal Business Name): GEOFFREY A TUCKER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK EAST SUITE 902
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

2080 CENTURY PARK EAST SUITE 902
LOS ANGELES CA
90067-2001
US

V. Phone/Fax

Practice location:
  • Phone: 310-556-0263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG16426
License Number StateCA

VIII. Authorized Official

Name: MARILYN NORMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-556-0263