Provider Demographics
NPI:1780683169
Name:CIESLA, THOMAS KARL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KARL
Last Name:CIESLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:STE 212
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2050
Mailing Address - Country:US
Mailing Address - Phone:310-315-0300
Mailing Address - Fax:310-315-0302
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:STE 212
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-315-0300
Practice Address - Fax:310-315-0302
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG97032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA061432OtherMANAGED HEALTH NETWORK
CA061432OtherMANAGED HEALTH NETWORK