Healthcare Provider Details

I. General information

NPI: 1689630295
Provider Name (Legal Business Name): GEOFFREY A TUCKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK EAST STE 902
LOS ANGELES CA
90067
US

IV. Provider business mailing address

2080 CENTURY PARK EAST STE 902
LOS ANGELES CA
90067
US

V. Phone/Fax

Practice location:
  • Phone: 310-556-0263
  • Fax: 310-556-0278
Mailing address:
  • Phone: 310-556-0263
  • Fax: 310-556-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: