Individual
MANUEL TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DRIVER LICENSE
Contact information
Practice address
322 STATE AVE UNIT 1123, SHAFTER, CA 93263-4072
(562) 341-3634
Mailing address
322 STATE AVE UNIT 1123, SHAFTER, CA 93263-4072
(562) 341-3634
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B7208559
CA
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
376J00000X
Homemaker
6058046735
CA
Other
Enumeration date
12/19/2023
Last updated
12/29/2023
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