Provider Demographics
NPI:1609607381
Name:WASHINGTON, TAIJAYLA GACRA
Entity type:Individual
Prefix:
First Name:TAIJAYLA
Middle Name:GACRA
Last Name:WASHINGTON
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 1:3623 NORTHDALE PL APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2241
Mailing Address - Country:US
Mailing Address - Phone:513-460-5907
Mailing Address - Fax:
Practice Address - Street 1:3623 NORTHDALE PL APT 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2241
Practice Address - Country:US
Practice Address - Phone:513-460-5907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant