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General NPI Number Information
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NPI Number | 1427826577
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Entity Type | Individual
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Provider Name | MANUEL TATUM DRIVER LICENSE
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Gender | Male
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 322 STATE AVE UNIT 1123
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City | SHAFTER
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State | CA
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Zip | 93263-4072
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Country | US
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Telephone | 562-341-3634
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Fax |
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Provider Business Mailing Address
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Address Line | 322 STATE AVE UNIT 1123
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City | SHAFTER
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State | CA
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Zip | 93263-4072
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Country | US
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Telephone | 562-341-3634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | B7208559
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 6058046735
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License Number State | CA
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