Healthcare Provider Details

I. General information

NPI: 1275455396
Provider Name (Legal Business Name): TIFFANY RACHEL MATIAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15701 VENTURA BLVD
ENCINO CA
91436-2903
US

IV. Provider business mailing address

15701 VENTURA BLVD
ENCINO CA
91436-2903
US

V. Phone/Fax

Practice location:
  • Phone: 310-749-0096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: