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General NPI Number Information
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NPI Number | 1952713851
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Entity Type | Individual
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Provider Name | JOLINE JEFFERSON TILLY M.D
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Gender | Female
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 801 S CHEVY CHASE DR
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City | GLENDALE
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State | CA
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Zip | 91205-4431
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Country | US
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Telephone | 818-500-5586
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Fax |
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Provider Business Mailing Address
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Address Line | 405 S OLD RANCH RD
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City | ARCADIA
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State | CA
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Zip | 91007-6229
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Country | US
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Telephone | 917-838-9563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A94824
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License Number State | CA
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