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NPI Code Detail

MEDICARE: TISLA WHITE

MEDICARE: TISLA WHITE
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
1225100000XPhysical Therapist26773CA

General Provider Information

NPI Number : 1417147364
Entity Type Code : Individual
Provider Name (Legal Business Name) : TISLA WHITE
Provider Business Mailing Address
First Line : 1145 W REDONDO BEACH BLVD
Second Line :
City : GARDENA
State : CA
Zip : 90247-3511
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1145 W REDONDO BEACH BLVD
Second Line :
City : GARDENA
State : CA
Zip : 90247-3511
Country : US
Telephone Number : 310-538-6598
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 07/26/2007

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Directions to “ TISLA WHITE ” Practice Location

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