Healthcare Provider Details

I. General information

NPI: 1386346617
Provider Name (Legal Business Name): TIFFANY HO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # MC8425
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

200 W ARBOR DR # MC8425
SAN DIEGO CA
92103-1911
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number207890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: