Healthcare Provider Details

I. General information

NPI: 1780621276
Provider Name (Legal Business Name): TARA A WASHINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44274 GEORGE CUSHMAN CT SUITE 100
TEMECULA CA
92592-5945
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 951-252-9300
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG88063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: