Healthcare Provider Details

I. General information

NPI: 1255577342
Provider Name (Legal Business Name): TASHA LAVONA MCNEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TASHA WILSON

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 37TH AVE
SAN MATEO CA
94403-4324
US

IV. Provider business mailing address

225 37TH AVE
SAN MATEO CA
94403-4324
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-3900
  • Fax: 650-573-2931
Mailing address:
  • Phone: 650-573-3900
  • Fax: 650-573-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: