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General NPI Number Information
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NPI Number | 1568671139
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Entity Type | Individual
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Provider Name | TIFFANY BRADFORD MT
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 105 E 3RD AVE
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City | SAN MATEO
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State | CA
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Zip | 94401-4012
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Country | US
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Telephone | 650-347-9666
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Fax |
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Provider Business Mailing Address
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Address Line | 24483 PLUMMER CT
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City | HAYWARD
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State | CA
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Zip | 94545-1948
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Country | US
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Telephone | 510-782-3378
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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 | 0635
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License Number State | CA
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