Provider Demographics
NPI:1750885646
Name:TULCHINSKY, MIKAYA BRANAE
Entity type:Individual
Prefix:
First Name:MIKAYA
Middle Name:BRANAE
Last Name:TULCHINSKY
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 1:901 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5465
Mailing Address - Country:US
Mailing Address - Phone:925-421-9519
Mailing Address - Fax:
Practice Address - Street 1:75 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1827
Practice Address - Country:US
Practice Address - Phone:925-421-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty