MEDICARE: DR. TUCKER PECK PH.D.

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
1	103TC0700X	Clinical Psychologist	4688	AZ

General Provider Information

NPI Number	:	1205291440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUCKER PECK PH.D.

Provider Business Mailing Address
First Line	:	2103 SAN JOSE AVE UNIT C
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4994
Country	:	US
Telephone Number	:	520-485-9411
Fax Number	:	844-227-8699

Provider Business Practice Location Address
First Line	:	2103 SAN JOSE AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4994
Country	:	US
Telephone Number	:	520-485-9411
Fax Number	:	844-227-8699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	11/02/2022

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