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General NPI Number Information
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NPI Number | 1205770682
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Entity Type | Individual
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Provider Name | TIFFANY HENDRIX LCMT, CMT
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Gender | Female
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 5389 PLAYA VISTA DR
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City | PLAYA VISTA
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State | CA
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Zip | 90094-2043
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Country | US
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Telephone | 310-975-5887
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 AMBLE DR
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City | SHOREVIEW
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State | MN
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Zip | 55126-2268
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Country | US
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Telephone | 310-975-5887
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2299
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 765186
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License Number State | CA
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