Provider Demographics
NPI:1376749952
Name:TUCKER, DON (HAD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41800 ENTERPRISE CIR S
Mailing Address - Street 2:SUITE A
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4831
Mailing Address - Country:US
Mailing Address - Phone:951-296-1600
Mailing Address - Fax:951-296-1602
Practice Address - Street 1:41800 ENTERPRISE CIR S
Practice Address - Street 2:SUITE A
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4831
Practice Address - Country:US
Practice Address - Phone:951-296-1600
Practice Address - Fax:951-296-1602
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2630237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist