Healthcare Provider Details

I. General information

NPI: 1992951347
Provider Name (Legal Business Name): THERESSIA LOUISE WASHINGTON M.D., M.S., FAAFP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 11/12/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9663 SANTA MONICA BLVD STE 957
BEVERLY HILLS CA
90210-4303
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD STE 957
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-8377
  • Fax: 310-276-8377
Mailing address:
  • Phone: 310-275-8377
  • Fax: 310-602-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA104439
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA104439
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number16152
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: