Provider Demographics
NPI:1013799790
Name:NEWSOME, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:NEWSOME
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 1:38072 CIMA MESA DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-3469
Mailing Address - Country:US
Mailing Address - Phone:661-547-4640
Mailing Address - Fax:888-761-8705
Practice Address - Street 1:38072 CIMA MESA DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3469
Practice Address - Country:US
Practice Address - Phone:661-547-4640
Practice Address - Fax:888-761-8705
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle