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NPI Code Detail

MEDICARE: JESSIE TATE

MEDICARE: JESSIE TATE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1114110368
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSIE TATE
Provider Business Mailing Address
First Line : 4501 TAFT AVE
Second Line :
City : RICHMOND
State : CA
Zip : 94804-3449
Country : US
Telephone Number : 510-235-3172
Fax Number : 510-235-0755
Provider Business Practice Location Address
First Line : 4501 TAFT AVE
Second Line :
City : RICHMOND
State : CA
Zip : 94804-3449
Country : US
Telephone Number : 510-235-3172
Fax Number : 510-235-0755
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2007
Last Update Date : 08/21/2007

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Directions to “ JESSIE TATE ” Practice Location

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