Provider Demographics
NPI:1861818197
Name:TUCKER, GENOVEVA
Entity Type:Individual
Prefix:
First Name:GENOVEVA
Middle Name:
Last Name:TUCKER
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 1:1441 CONSTITUTION BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3127
Mailing Address - Country:US
Mailing Address - Phone:831-796-1700
Mailing Address - Fax:831-769-0552
Practice Address - Street 1:1441 CONSTITUTION BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3127
Practice Address - Country:US
Practice Address - Phone:831-796-1700
Practice Address - Fax:831-769-0552
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 267401164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse