Healthcare Provider Details

I. General information

NPI: 1639435605
Provider Name (Legal Business Name): DAJZEE CYPRIANA TUCKER ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 ALAMEDA ST
LYNWOOD CA
90262
US

IV. Provider business mailing address

535 W 3RD ST 8
LONG BEACH CA
90802-2720
US

V. Phone/Fax

Practice location:
  • Phone: 323-568-4979
  • Fax:
Mailing address:
  • Phone: 310-346-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: