Healthcare Provider Details

I. General information

NPI: 1396084125
Provider Name (Legal Business Name): TIFFANY LOPEZ L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 MACARTHUR BLVD
OAKLAND CA
94602-2929
US

IV. Provider business mailing address

1951 42ND AVE
OAKLAND CA
94601-4208
US

V. Phone/Fax

Practice location:
  • Phone: 510-550-5221
  • Fax:
Mailing address:
  • Phone: 510-550-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18646
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: