Provider Demographics
NPI:1629404744
Name:TATOM, STEPHEN ASIAIN (CNOR, RNFA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ASIAIN
Last Name:TATOM
Suffix:
Gender:M
Credentials:CNOR, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 108 - UPS STORE - PMB 258
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1643
Mailing Address - Country:US
Mailing Address - Phone:707-319-2462
Mailing Address - Fax:707-998-7632
Practice Address - Street 1:300 HOSPITAL DR
Practice Address - Street 2:SUTTER SOLANO MEDICAL CENTER
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2574
Practice Address - Country:US
Practice Address - Phone:707-554-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612883163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant