Individual
MR. TYJUAN COWELL SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3059 EXPLORER DR, SACRAMENTO, CA 95827-2718
(757) 405-2308
Mailing address
3059 EXPLORER DR, SACRAMENTO, CA 95827-2718
(757) 405-2308
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
W9967844
CA
Other
Enumeration date
05/13/2025
Last updated
05/13/2025
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