Basic Information
| Provider Information | |||||||||
| NPI: | 1699102095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | TYLESHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 E WASHINGTON ST APT 348 | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923248195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096851297 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2523 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900573801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134801557 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2013 | ||||||||
| LastUpdateDate: | 09/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | 35813 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.