Healthcare Provider Details

I. General information

NPI: 1073446472
Provider Name (Legal Business Name): TIFFANY MARELLE INGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 E ARROW HWY
POMONA CA
91767-2587
US

IV. Provider business mailing address

115 N NEW HAMPSHIRE AVE APT 104
LOS ANGELES CA
90004-4892
US

V. Phone/Fax

Practice location:
  • Phone: 909-802-9052
  • Fax:
Mailing address:
  • Phone: 909-802-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: