Provider Demographics
NPI:1902657802
Name:TSIANE, PONTSHO PRIDESWORTH
Entity Type:Individual
Prefix:
First Name:PONTSHO
Middle Name:PRIDESWORTH
Last Name:TSIANE
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 1:5600 BANCROFT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1059
Mailing Address - Country:US
Mailing Address - Phone:510-603-8014
Mailing Address - Fax:
Practice Address - Street 1:5600 BANCROFT AVE APT B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-1059
Practice Address - Country:US
Practice Address - Phone:510-603-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula