MEDICARE: MRS. TAMIKA TAMU GLENN PHLEBPTOMIST

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	CPT-02473540	CA

General Provider Information

NPI Number	:	1902760986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMIKA TAMU GLENN PHLEBPTOMIST

Provider Business Mailing Address
First Line	:	5350 DELTA DR
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-5179
Country	:	US
Telephone Number	:	279-262-4263
Fax Number	:	279-246-5247

Provider Business Practice Location Address
First Line	:	5350 DELTA DR
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-5179
Country	:	US
Telephone Number	:	279-262-4263
Fax Number	:	279-246-5247

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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