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NPI Code Detail

MEDICARE: SAMUEL FRANCISCO TINAJERO DECK

MEDICARE: SAMUEL FRANCISCO TINAJERO DECK
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
1172V00000XCommunity Health Worker
2101Y00000XCounselor
3171M00000XCase Manager/Care Coordinator
4390200000XStudent in an Organized Health Care Education/Training ProgramCA
5104100000XSocial WorkerCA

General Provider Information

NPI Number : 1184268542
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL FRANCISCO TINAJERO DECK
Provider Business Mailing Address
First Line : 8945 GOLF LINKS RD
Second Line :
City : OAKLAND
State : CA
Zip : 94605-4124
Country : US
Telephone Number : 510-317-1444
Fax Number :
Provider Business Practice Location Address
First Line : 8945 GOLF LINKS RD
Second Line :
City : OAKLAND
State : CA
Zip : 94605-4124
Country : US
Telephone Number : 510-688-8504
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2019
Last Update Date : 06/15/2026

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