Basic Information
| Provider Information | |||||||||
| NPI: | 1396390712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOTEN | ||||||||
| FirstName: | TRAMESHA | ||||||||
| MiddleName: | ALENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4930 NAPLES ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192761176 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5755 OBERLIN DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921214717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002491266 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2019 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.