MEDICARE: MS. TAMARA FUCCI CMT, HE

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	225700000X	Massage Therapist		CA

General Provider Information

NPI Number	:	1366782955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA FUCCI CMT, HE

Provider Business Mailing Address
First Line	:	9154 E STOCKTON BLVD
Second Line	:	SUITE 120
City	:	ELK GROVE
State	:	CA
Zip	:	95624-9511
Country	:	US
Telephone Number	:	916-714-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	9154 E STOCKTON BLVD
Second Line	:	SUITE 120
City	:	ELK GROVE
State	:	CA
Zip	:	95624-9511
Country	:	US
Telephone Number	:	916-714-3400
Fax Number	:

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

Provider Enumeration Date	:	02/19/2013
Last Update Date	:	02/19/2013

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