Travon Di Angelo Tillis in South Pasadena - Clinical
Travon Di Angelo Tillis - NPI 1740407576
Travon Di Angelo Tillis is a Clinical in South Pasadena, California. Travon Di Angelo Tillis practices all healthcare services and medical treatments related to Clinical. The NPI Number for Travon Di Angelo Tillis is 1740407576. The last update date is 2023-09-11.
Travon Di Angelo Tillis's current location address is 625 Fair Oaks Ave, South Pasadena, California. You can contact this provider via phone number 6263957100. The mailing address for Travon Di Angelo Tillis is 625 Fair Oaks Ave, South Pasadena, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Travon Di Angelo Tillis |
|---|---|
| Address | 625 Fair Oaks Ave, South Pasadena, California |
| Phone Number | 6263957100 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1740407576 |
|---|---|
| Provider Enumeration Date | 2007-04-20 |
| Last Updated Date | 2023-09-11 |
Provider Mailing Address Detail
| Address | 625 Fair Oaks Ave |
|---|---|
| City | South Pasadena |
| State | California (CA) |
| Post Code | 910302630 |
| Phone Number | 6263957100 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 1041C0700X |
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Definition: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certif |
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What is the unique 10-digit identification code assigned to Travon Di Angelo Tillis by the Centers for Medicare & Medicaid Services?
The Travon Di Angelo Tillis has been issued the NPI (National Provider Identifier) 1740407576, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you kindly provide the complete physical address where Travon Di Angelo Tillis's facilities are geographically located?
The facilities of Travon Di Angelo Tillis are physically situated at the following location: 625 Fair Oaks Ave, South Pasadena, CA, 910302630.
What is the Travon Di Angelo Tillis's specialty and taxonomy code?
The Travon Di Angelo Tillis's specialty is Clinical, and the corresponding taxonomy code is 1041C0700X.
On what date did the Centers for Medicare & Medicaid Services issue the 1740407576 to Travon Di Angelo Tillis?
The Travon Di Angelo Tillis received its 1740407576 assignment from the Centers for Medicare & Medicaid Services on 2007-04-20.
As of what date were the details pertaining to Travon Di Angelo Tillis last refreshed?
The information related to the Travon Di Angelo Tillis, including its address, specialty, and other relevant details, was last updated on 2023-09-11.