Individual provider Active NPI

Prescillia Miandabo Tshiamala, FNP-BC

  • Family Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1043455140
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
18627 Issued in CA
Practice address
1520 San Pablo St Ste 1000
Los Angeles, CA 90033-5312
Phone
(323) 442-5100
NPI assigned
Dec 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 18627 CA Primary

Addresses

Primary practice location

1520 San Pablo St Ste 1000
Los Angeles, CA 90033-5312

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-5100

Other names 1

  • Ms. Prescilla Miandabo Tshiamala Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120524000593 CA Practitioner - Nurse Practitioner 6507029725 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

1031 W 34TH St
Los Angeles, CA 90089-3621
Phone (213) 821-6500

1500 San Pablo St
Los Angeles, CA 90033-5313
Phone (323) 442-8444

1516 San Pablo St
Los Angeles, CA 90033-5313
Phone (800) 872-2273

1520 San Pablo St
Los Angeles, CA 90033-5310
Phone (800) 872-2273

1520 San Pablo St 1St Floor N
Los Angeles, CA 90033-5310
Phone (800) 872-2273

625 S Fair Oaks Ave
Suite 250
Pasadena, CA 91105-2613
Phone (626) 795-5848

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Nov 1, 2024 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Aug 31, 2013 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Aug 31, 2013 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Nov 1, 2024 Accepting new patients
Healthcare Partners Affiliates Medical Group Current Accepting new patients
Memorial Medical Group Inc Past Accepting new patients

Locations

440 E Huntington Dr
Arcadia, CA 91006
Phone (626) 254-2293

450 E Huntington Dr
Arcadia, CA 91006
Phone (626) 254-2100

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1520 San Pablo St
Ste 1000
Los Angeles, CA 90033
Phone (626) 457-5839

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1043455140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST STE 1000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335312",
            "telephone_number": "323-442-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSHIAMALA",
        "first_name": "PRESCILLIA",
        "middle_name": "MIANDABO",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-04",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "18627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PRESCILLA",
            "last_name": "TSHIAMALA",
            "middle_name": "MIANDABO",
            "prefix": "MS.",
            "credential": "FNP-BC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.