Provider Demographics
NPI:1578882569
Name:ANDERSON, ASHAUNTA TUMBLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHAUNTA
Middle Name:TUMBLIN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHAUNTA
Other - Middle Name:RACHELLE
Other - Last Name:TUMBLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4650 W SUNSET BLVD # 53
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-3849
Mailing Address - Fax:323-361-4429
Practice Address - Street 1:4650 W SUNSET BLVD # 53
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-3849
Practice Address - Fax:323-361-4429
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116905208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice