Provider Demographics
NPI:1003466418
Name:TISCHMAN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TISCHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14687 AVENIDA CENTRAL
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:CA
Mailing Address - Zip Code:95329-9799
Mailing Address - Country:US
Mailing Address - Phone:209-852-2583
Mailing Address - Fax:
Practice Address - Street 1:14687 AVENIDA CENTRAL
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:CA
Practice Address - Zip Code:95329-9799
Practice Address - Country:US
Practice Address - Phone:209-852-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider