MEDICARE: TIFFANY ROCHELLE ROYSDEN COSMETOLOGY

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
1	174400000X	Specialist	KK496544	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275466005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY ROCHELLE ROYSDEN COSMETOLOGY

Provider Business Mailing Address
First Line	:	5225 FULTON AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5906
Country	:	US
Telephone Number	:	310-948-4656
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 FUTON AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401
Country	:	US
Telephone Number	:	310-948-4656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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