Healthcare Provider Details

I. General information

NPI: 1437442662
Provider Name (Legal Business Name): TIFFANY CATHERINE JUMAILY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 305
LOS ANGELES CA
90067-2006
US

IV. Provider business mailing address

2080 CENTURY PARK E STE 305
LOS ANGELES CA
90067-2006
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-4586
  • Fax: 310-657-0986
Mailing address:
  • Phone: 310-657-4586
  • Fax: 310-657-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number258112
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number147000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: