Provider Demographics
NPI:1043455140
Name:TSHIAMALA, PRESCILLIA MIANDABO (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PRESCILLIA
Middle Name:MIANDABO
Last Name:TSHIAMALA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:PRESCILLA
Other - Middle Name:MIANDABO
Other - Last Name:TSHIAMALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:609 N MAR VISTA AVE
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4908
Mailing Address - Country:US
Mailing Address - Phone:734-904-1935
Mailing Address - Fax:
Practice Address - Street 1:3834 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1104
Practice Address - Country:US
Practice Address - Phone:323-730-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily