| NPI | 1861069957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHYLEE B TIAMSON Nurse Practitioner 310-292-0117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2083X0100X Preventive Medicine Occupational Medicine | |
| 363AM0700X Physician Assistant Medical | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2022-04-22 |