Healthcare Provider Details

I. General information

NPI: 1417621459
Provider Name (Legal Business Name): MARY TIFFANY T MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FRANKLIN ST
SAN FRANCISCO CA
94109-4523
US

IV. Provider business mailing address

6630 MISSION ST APT B
DALY CITY CA
94014-2028
US

V. Phone/Fax

Practice location:
  • Phone: 415-474-7310
  • Fax:
Mailing address:
  • Phone: 661-370-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: