Healthcare Provider Details

I. General information

NPI: 1770542664
Provider Name (Legal Business Name): TIFFANY LAINE KINGSBURY TECHNICIANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EAGLE RD BLDG 1
ALAMEDA CA
94501-5100
US

IV. Provider business mailing address

USCG HQ COMDT (CG-1122) 2100 SECOND ST., SW
WASHINGTON DC
20593-0001
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-3582
  • Fax: 510-437-3300
Mailing address:
  • Phone: 202-475-5181
  • Fax: 202-475-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: