Provider Information for 1295935567
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Ms. TIEAESHA S. GAINES
Sex: Female
NPI: 1295935567
Last Updated: 2024-05-30
Certification Date: 2024-05-30
Certification Date: 2024-05-30
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1295935567 | ||||||||
| Enumeration Date | 2007-07-24 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1291 OAKLAND BLVD WALNUT CREEK, CA 94596-4359 United States Phone: 925-876-0767 | Fax:925-933-5824 | ||||||||
| Primary Practice Address | 1291 OAKLAND BLVD WALNUT CREEK, CA 94596-4359 United States Phone: 925-876-0767 | Fax:925-933-5824 | ||||||||
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