Provider Demographics
NPI:1922040849
Name:TILLIS, TOYA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TOYA
Middle Name:ANN
Last Name:TILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:250 W BONITA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1863
Mailing Address - Country:US
Mailing Address - Phone:909-629-5067
Mailing Address - Fax:909-865-7688
Practice Address - Street 1:250 W BONITA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1863
Practice Address - Country:US
Practice Address - Phone:909-629-5067
Practice Address - Fax:909-865-7688
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA75203208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics