MEDICARE: THERESSIA L WASHINGTON MD PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QU0200X	Urgent Care Clinic/Center
3	282E00000X	Long Term Care Hospital
4	282N00000X	General Acute Care Hospital
5	314000000X	Skilled Nursing Facility
6	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1811685100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERESSIA L WASHINGTON MD PC

Provider Business Mailing Address
First Line	:	9663 SANTA MONICA BLVD STE 957
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4303
Country	:	US
Telephone Number	:	310-275-8377
Fax Number	:	310-276-8377

Provider Business Practice Location Address
First Line	:	1355 N SIERRA BONITA AVE APT 206
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-8516
Country	:	US
Telephone Number	:	310-275-8377
Fax Number	:	310-276-8377

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. THERESSIA LOUISE WASHINGTON
Credential	:	MD
Telephone Number	:	310-275-8377

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	04/25/2023

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