Healthcare Provider Details

I. General information

NPI: 1548606254
Provider Name (Legal Business Name): TIFFANY CHIOMA ANAEBERE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

4800 UNIVERSITY DR APT 20D
DURHAM NC
27707-6124
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4564
  • Fax:
Mailing address:
  • Phone: 323-788-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA134199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: