Provider Demographics
NPI:1376215491
Name:PRECIADO, TILISHA D
Entity type:Individual
Prefix:
First Name:TILISHA
Middle Name:D
Last Name:PRECIADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:ESCALON
Mailing Address - State:CA
Mailing Address - Zip Code:95320-1804
Mailing Address - Country:US
Mailing Address - Phone:209-838-3524
Mailing Address - Fax:209-838-6855
Practice Address - Street 1:1710 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-1804
Practice Address - Country:US
Practice Address - Phone:209-838-3524
Practice Address - Fax:209-838-6855
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician