Provider Demographics
NPI:1851670202
Name:TUMBAGA, MARIA FATIMA S
Entity Type:Individual
Prefix:
First Name:MARIA FATIMA
Middle Name:S
Last Name:TUMBAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14902 SHELBORNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9668
Mailing Address - Country:US
Mailing Address - Phone:317-286-2885
Mailing Address - Fax:317-388-0805
Practice Address - Street 1:14902 SHELBORNE RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9668
Practice Address - Country:US
Practice Address - Phone:317-286-2885
Practice Address - Fax:317-388-0805
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639336171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor