Individual
NICHOLE TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
16088 GERANIUM CT, MORENO VALLEY, CA 92551-7292
(951) 229-9000
Mailing address
16088 GERANIUM CT, MORENO VALLEY, CA 92551-7292
(951) 229-9000
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
69826
CA
Other
Enumeration date
06/21/2016
Last updated
06/21/2016
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