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NPI Code Detail

MEDICARE: MAISHA DOMINIQUE TAWASHA

MEDICARE: MAISHA DOMINIQUE TAWASHA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1154154961
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAISHA DOMINIQUE TAWASHA
Provider Business Mailing Address
First Line : 3081 TEAGARDEN ST
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-5720
Country : US
Telephone Number : 510-347-4620
Fax Number :
Provider Business Practice Location Address
First Line : 3081 TEAGARDEN ST
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-5720
Country : US
Telephone Number : 510-347-4620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2024
Last Update Date : 12/18/2025

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Directions to “ MAISHA DOMINIQUE TAWASHA ” Practice Location

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