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General NPI Number Information
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NPI Number | 1053615658
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Entity Type | Organization
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Legal Business Name | TIFFANY ELIZABETH ELLIS
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Dates
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Enumeration Date | 12/22/2010
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 4101 TORRANCE BLVD
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City | TORRANCE
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State | CA
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Zip | 90503-4607
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Country | US
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Telephone | 310-944-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 4170 ADMIRALTY WAY APT 316
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6257
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Country | US
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Telephone | 954-258-0716
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. TIFFANY ELIZABETH ELLIS
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Credential | D.O.
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Telephone | 954-258-0716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 20A11353
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License Number State | CA
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