Basic Information
| Provider Information | |||||||||
| NPI: | 1073040937 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUCKER | ||||||||
| FirstName: | JALIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939053302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317570434 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 122 E SAN ANTONIO DR | ||||||||
| Address2: | |||||||||
| City: | KING CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939302518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313855944 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2017 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 169992 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.