MEDICARE: MS. TAWANDA P RAYFIELD

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1770128324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAWANDA P RAYFIELD

Provider Business Mailing Address
First Line	:	PO BOX 40332
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-6332
Country	:	US
Telephone Number	:	562-234-7484
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 W 6TH ST APT 310
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-1309
Country	:	US
Telephone Number	:	562-234-7484
Fax Number	:

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

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/07/2019

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