Healthcare Provider Details

I. General information

NPI: 1326881822
Provider Name (Legal Business Name): THOMAS WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W 41ST DR
LOS ANGELES CA
90062-1517
US

IV. Provider business mailing address

1811 W 41ST DR
LOS ANGELES CA
90062-1517
US

V. Phone/Fax

Practice location:
  • Phone: 323-348-4615
  • Fax:
Mailing address:
  • Phone: 323-348-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: