Provider Demographics
NPI:1831669225
Name:ANDERSON, TSHOLOFELO NCHALE
Entity Type:Individual
Prefix:MRS
First Name:TSHOLOFELO
Middle Name:NCHALE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TSHOLOFELO
Other - Middle Name:NCHALE
Other - Last Name:OTUKILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT,AE-C
Mailing Address - Street 1:295 HERON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-1916
Mailing Address - Country:US
Mailing Address - Phone:510-468-6645
Mailing Address - Fax:
Practice Address - Street 1:275 W MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5641
Practice Address - Country:US
Practice Address - Phone:510-303-0628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146842278G1100X, 2279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
No2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care