Healthcare Provider Details

I. General information

NPI: 1982949343
Provider Name (Legal Business Name): TIFFANY D SANI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N SWALL DR PH8
LOS ANGELES CA
90048-6807
US

IV. Provider business mailing address

128 N SWALL DR PH8
LOS ANGELES CA
90048-6807
US

V. Phone/Fax

Practice location:
  • Phone: 818-314-1414
  • Fax:
Mailing address:
  • Phone: 818-314-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: