Provider Demographics
NPI:1356947238
Name:TSITSUASHVILI, DAVID TAMAZOVICH (MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:TAMAZOVICH
Last Name:TSITSUASHVILI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 S SWALL DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1312
Mailing Address - Country:US
Mailing Address - Phone:818-687-6042
Mailing Address - Fax:
Practice Address - Street 1:1140 S SWALL DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1312
Practice Address - Country:US
Practice Address - Phone:818-687-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist