MEDICARE: TENAJE SAM MA-P

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	246RP1900X	Phlebotomy Technician	60635715	WA
2	246RP1900X	Phlebotomy Technician	PC60635715	WA
3	251E00000X	Home Health Agency	PC60635715	WA

General Provider Information

NPI Number	:	1346064714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENAJE SAM MA-P

Provider Business Mailing Address
First Line	:	2341 S J ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-3831
Country	:	US
Telephone Number	:	253-973-1623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2341 S J ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-3831
Country	:	US
Telephone Number	:	253-973-1623
Fax Number	:

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

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	03/10/2026

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Directions to “ TENAJE SAM MA-P” Practice Location

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