Provider Demographics
NPI:1285365908
Name:DESWERT, TIA RACHAEL
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:RACHAEL
Last Name:DESWERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:GOTOTWESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 CAMINO DEL RIO S STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3504
Mailing Address - Country:US
Mailing Address - Phone:619-381-7748
Mailing Address - Fax:
Practice Address - Street 1:409 CAMINO DEL RIO S STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3504
Practice Address - Country:US
Practice Address - Phone:619-381-7748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health