Provider Demographics
NPI:1912787920
Name:MASON, TAMMY TAMIESHA
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:TAMIESHA
Last Name:MASON
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 1:5651 N PERSHING AVE STE B4
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4947
Mailing Address - Country:US
Mailing Address - Phone:209-395-3980
Mailing Address - Fax:209-251-6614
Practice Address - Street 1:5651 N PERSHING AVE STE B4
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4947
Practice Address - Country:US
Practice Address - Phone:209-395-3980
Practice Address - Fax:209-251-6614
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA394700047OtherNON-MEDICAL HOME CARE