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NPI Code Detail

MEDICARE: EVAMAE AURELIA TUCKER

MEDICARE: EVAMAE AURELIA TUCKER
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1154956324
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAMAE AURELIA TUCKER
Provider Business Mailing Address
First Line : 537 W 8TH ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-3119
Country : US
Telephone Number : 714-617-4886
Fax Number :
Provider Business Practice Location Address
First Line : 537 W 8TH ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-3119
Country : US
Telephone Number : 714-617-4886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2020
Last Update Date : 04/12/2022

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Directions to “ EVAMAE AURELIA TUCKER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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