Healthcare Provider Details

I. General information

NPI: 1275748881
Provider Name (Legal Business Name): TONYA YVETTE TOWNSEND D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9854 NATIONAL BLVD # 408
LOS ANGELES CA
90034-2713
US

IV. Provider business mailing address

9854 NATIONAL BLVD # 408
LOS ANGELES CA
90034-2713
US

V. Phone/Fax

Practice location:
  • Phone: 909-557-4547
  • Fax:
Mailing address:
  • Phone: 909-557-4547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number10225
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: