Healthcare Provider Details

I. General information

NPI: 1326363524
Provider Name (Legal Business Name): TIFFANY FU YU MA, OTR/L, SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 ARIZONA PL SUITE A
LOS ANGELES CA
90045-1252
US

IV. Provider business mailing address

11605 WASHINGTON PL
LOS ANGELES CA
90066-5013
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7115
  • Fax: 310-216-6153
Mailing address:
  • Phone: 310-337-7115
  • Fax: 310-216-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: