Healthcare Provider Details

I. General information

NPI: 1780782060
Provider Name (Legal Business Name): TIFFANY ROGERS, M.D., M.P.T, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD SUITE 300
TORRANCE CA
90505-4716
US

IV. Provider business mailing address

23456 HAWTHORNE BLVD SUITE 300
TORRANCE CA
90505-4716
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-6190
  • Fax: 310-540-7362
Mailing address:
  • Phone: 310-316-6190
  • Fax: 310-540-7362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA70813
License Number StateCA

VIII. Authorized Official

Name: DR. TIFFANY ROGERS
Title or Position: MD
Credential: MD
Phone: 310-316-6190