Individual
DR. BETHANY JAYNE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9911 W PICO BLVD, LOS ANGELES, CA 90035-2703
(310) 556-0255
Mailing address
16622 JOSHUA RD, APPLE VALLEY, CA 92307-1913
(760) 247-5410
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A73695
CA
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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