Healthcare Provider Details

I. General information

NPI: 1447798095
Provider Name (Legal Business Name): MRS. TIFFANY DAWN ZUREIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. TIFFANY DAWN ROGERS

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MALECH ROAD
SAN JOSE CA
95138
US

IV. Provider business mailing address

88 N JACKSON AVE UNIT 219
SAN JOSE CA
95116-3471
US

V. Phone/Fax

Practice location:
  • Phone: 408-281-6555
  • Fax:
Mailing address:
  • Phone: 408-466-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: