Douglas Anthony Tucker Sr., MHS CATC IV 155671
Substance Abuse Rehabilitation Facility in Santa Ana, CA. Individual provider (NPI-1).
NPI number1376901017
StatusActive
Last updated in NPPESFeb 9, 2016
Details
- NPI
- 1376901017
- Entity type
- Individual (NPI-1)
- Name
- Mr. Douglas Anthony Tucker Sr.
- Credential
- MHS CATC IV 155671
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 9, 2016
- Last updated
- Feb 9, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 324500000X | Substance Abuse Rehabilitation Facility | 300033CN | CA | Yes |
Practice location
1207 E Fruit StSanta Ana, CA 92701-4206
Phone 714-953-9373 · Fax 714-953-7573
Mailing address
1207 E Fruit StSanta Ana, CA 92701-4206
Phone 714-953-9373 · Fax 714-953-7573
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