Healthcare Provider Details

I. General information

NPI: 1528191665
Provider Name (Legal Business Name): TIFFANY YIP MFTINTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 HUNTINGTON DR
SOUTH PASADENA CA
91030-4511
US

IV. Provider business mailing address

PO BOX 92169
PASADENA CA
91109-2169
US

V. Phone/Fax

Practice location:
  • Phone: 323-243-8536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: