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General NPI Number Information
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NPI Number | 1437493558
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Entity Type | Organization
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Legal Business Name | KATHRYN PERKINS TIFT MD INC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 11160 WARNER AVE STE 311
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City | FOUNTAIN
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State | CA
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Zip | 92708-4055
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Country | US
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Telephone | 714-850-7300
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Fax | 714-957-7348
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Provider Business Mailing Address
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Address Line | 11160 WARNER AVE STE 311
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City | FOUNTAIN
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State | CA
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Zip | 92708-4055
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Country | US
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Telephone | 714-850-7300
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Fax | 714-957-7348
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHRYN CALDWELL PERKINS TIFT
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Credential | M.D.
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Telephone | 714-850-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | A104909
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License Number State | CA
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