Healthcare Provider Details

I. General information

NPI: 1124854567
Provider Name (Legal Business Name): MISS HOPE TIFFANY BUHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 S SEPULVEDA BLVD STE 401
LOS ANGELES CA
90045-3646
US

IV. Provider business mailing address

13488 MAXELLA AVE APT 326
MARINA DEL REY CA
90292-4325
US

V. Phone/Fax

Practice location:
  • Phone: 310-645-5227
  • Fax: 310-645-9840
Mailing address:
  • Phone: 213-800-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: