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NPI Code Detail

MEDICARE: MISS TIFFANY MICHELLE WINSTON

MEDICARE: MISS TIFFANY MICHELLE WINSTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental HealthD1396406CA

General Provider Information

NPI Number : 1023216926
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TIFFANY MICHELLE WINSTON
Provider Business Mailing Address
First Line : 3331 N CREST DR
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4462
Country : US
Telephone Number : 909-802-9080
Fax Number :
Provider Business Practice Location Address
First Line : 704 W 8TH ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-3017
Country : US
Telephone Number : 310-832-7545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 07/08/2007

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Directions to “ MISS TIFFANY MICHELLE WINSTON ” Practice Location

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