Healthcare Provider Details

I. General information

NPI: 1760649362
Provider Name (Legal Business Name): TIFFANI JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST STE 2100
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST STE 2100
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-1386
  • Fax: 916-734-7950
Mailing address:
  • Phone: 916-734-1386
  • Fax: 916-734-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number447007
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: