Provider Demographics
NPI:1164103461
Name:TUMMY ROOM
Entity Type:Organization
Organization Name:TUMMY ROOM
Other - Org Name:THE TUMMY ROOM LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-609-7988
Mailing Address - Street 1:11 MARIA VEGA CT
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3851
Mailing Address - Country:US
Mailing Address - Phone:510-609-7988
Mailing Address - Fax:
Practice Address - Street 1:11 MARIA VEGA CT
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3851
Practice Address - Country:US
Practice Address - Phone:510-609-7988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty