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NPI Code Detail

MEDICARE: TIFFANY NAKAMURA

MEDICARE: TIFFANY NAKAMURA
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 Health CounselorLPCC4383CA

General Provider Information

NPI Number : 1356846349
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY NAKAMURA
Provider Business Mailing Address
First Line : 4510 EXECUTIVE DR STE 315
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3029
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4510 EXECUTIVE DR STE 315
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3029
Country : US
Telephone Number : 808-728-9606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2018
Last Update Date : 03/29/2018

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Directions to “ TIFFANY NAKAMURA ” Practice Location

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