Healthcare Provider Details

I. General information

NPI: 1346549938
Provider Name (Legal Business Name): TIFFANY T POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PIERCE ST
SAN FRANCISCO CA
94115-4005
US

IV. Provider business mailing address

1301 PIERCE ST
SAN FRANCISCO CA
94115-4005
US

V. Phone/Fax

Practice location:
  • Phone: 415-563-8200
  • Fax: 415-563-5985
Mailing address:
  • Phone: 415-563-8200
  • Fax: 415-563-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: