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NPI Code Detail

MEDICARE: DR. THERESSIA LOUISE WASHINGTON M.D., M.S., FAAFP

MEDICARE: DR. THERESSIA LOUISE WASHINGTON M.D., M.S., FAAFP
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
1208600000XSurgery PhysicianA104439CA
2208M00000XHospitalist Physician16152NV
3207Q00000XFamily Medicine PhysicianA104439CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A104439OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1992951347
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THERESSIA LOUISE WASHINGTON M.D., M.S., FAAFP
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 : 310-602-6390
Provider Business Practice Location 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
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2008
Last Update Date : 11/12/2020

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