Provider Demographics
NPI:1992951347
Name:WASHINGTON, THERESSIA LOUISE (MD, MS, FAAFP)
Entity type:Individual
Prefix:DR
First Name:THERESSIA
Middle Name:LOUISE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MD, MS, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9663 SANTA MONICA BLVD STE 957
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-275-8377
Mailing Address - Fax:310-602-6390
Practice Address - Street 1:9663 SANTA MONICA BLVD STE 957
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4303
Practice Address - Country:US
Practice Address - Phone:310-275-8377
Practice Address - Fax:310-276-8377
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104439208600000X, 207Q00000X
NV16152208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA104439OtherMEDICAL LICENSE