Healthcare Provider Details

I. General information

NPI: 1235551888
Provider Name (Legal Business Name): GHISLAINE TILLEY SWITZ M.S., D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 WILSHIRE BLVD STE 1040
LOS ANGELES CA
90025-7131
US

IV. Provider business mailing address

12100 WILSHIRE BLVD STE 1040
LOS ANGELES CA
90025-7131
US

V. Phone/Fax

Practice location:
  • Phone: 310-838-9300
  • Fax: 310-838-9300
Mailing address:
  • Phone: 310-838-9300
  • Fax: 310-838-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number18375
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number12432
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number012203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: