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General NPI Number Information
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NPI Number | 1003100728
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Entity Type | Individual
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Provider Name | TIFFANY JUTERBOCK ROBERTS PSYD, LMFT 53905
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Gender | Female
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 17140 BERNARDO CENTER DR
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City | SAN DIEGO
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State | CA
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Zip | 92128-2093
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Country | US
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Telephone | 858-451-5190
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Fax | 588-451-5199
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Provider Business Mailing Address
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Address Line | 5400 KEARNY MESA RD
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City | SAN DIEGO
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State | CA
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Zip | 92111-1303
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Country | US
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Telephone | 619-717-2363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 53905
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License Number State | CA
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