Healthcare Provider Details

I. General information

NPI: 1245966498
Provider Name (Legal Business Name): TAI LEXUME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 WING ST
SAN DIEGO CA
92110-4638
US

IV. Provider business mailing address

3255 WING ST
SAN DIEGO CA
92110-4638
US

V. Phone/Fax

Practice location:
  • Phone: 619-241-0608
  • Fax:
Mailing address:
  • Phone: 619-335-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: