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General NPI Number Information
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NPI Number | 1225433501
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Entity Type | Organization
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Legal Business Name | TIFERES MEDICAL GROUP
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 1020 CORPORATION WAY SUITE 207
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City | PALO ALTO
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State | CA
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Zip | 94303-4328
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Country | US
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Telephone | 650-704-1867
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 CORPORATION WAY SUITE 207
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City | PALO ALTO
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State | CA
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Zip | 94303-4328
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Country | US
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Telephone | 650-704-1867
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. HAIM TEBEKA
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Credential |
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Telephone | 650-704-3168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 15375
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License Number State | CA
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