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NPI Code Detail

MEDICARE: TATUM RENE LITTLE PHYSICIAN ASSISTANT

MEDICARE: TATUM RENE LITTLE PHYSICIAN ASSISTANT
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
1363A00000XPhysician Assistant58480CA

General Provider Information

NPI Number : 1154929644
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATUM RENE LITTLE PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 200 E ANAHEIM ST
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-4516
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5326 E BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90022-2104
Country : US
Telephone Number : 866-590-6411
Fax Number : 323-476-0397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2020
Last Update Date : 10/28/2024

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