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NPI Code Detail

MEDICARE: TIFFANY S. MARSHALL

MEDICARE: TIFFANY S. MARSHALL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1023135092
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY S. MARSHALL
Provider Business Mailing Address
First Line : 95 N MERIDITH AVE
Second Line : #3
City : PASADENA
State : CA
Zip : 91106-2222
Country : US
Telephone Number : 626-394-1384
Fax Number :
Provider Business Practice Location Address
First Line : 867 N FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91103-3050
Country : US
Telephone Number : 626-798-6793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 06/27/2023

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