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NPI Code Detail

MEDICARE: CHEYENNE MIKAYLAH TIPTON

MEDICARE: CHEYENNE MIKAYLAH TIPTON
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1386296317
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHEYENNE MIKAYLAH TIPTON
Provider Business Mailing Address
First Line : 6644 GLADE AVE APT 212
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91303-2533
Country : US
Telephone Number : 818-337-8050
Fax Number :
Provider Business Practice Location Address
First Line : 5741 LAS VIRGENES RD STE A
Second Line :
City : CALABASAS
State : CA
Zip : 91302-1273
Country : US
Telephone Number : 818-712-8257
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2019
Last Update Date : 07/10/2019

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Directions to “ CHEYENNE MIKAYLAH TIPTON ” Practice Location

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