Healthcare Provider Details

I. General information

NPI: 1568314912
Provider Name (Legal Business Name): XIAO LI TIAN TELEISHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 5TH AVE UNIT 8
SAN DIEGO CA
92101-2104
US

IV. Provider business mailing address

2214 5TH AVE UNIT 8
SAN DIEGO CA
92101-2104
US

V. Phone/Fax

Practice location:
  • Phone: 858-280-5722
  • Fax:
Mailing address:
  • Phone: 858-280-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number96046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: