Provider Demographics
NPI:1992050884
Name:IXTA-HOWARD, TONYA KELLI (LPT)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:KELLI
Last Name:IXTA-HOWARD
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S. VERMONT AVE. 21ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1992
Mailing Address - Country:US
Mailing Address - Phone:626-215-3864
Mailing Address - Fax:
Practice Address - Street 1:510 S. VERMONT AVE. 21ST FLOOR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1992
Practice Address - Country:US
Practice Address - Phone:626-215-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36580167G00000X
36580167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician