MEDICARE: TIFFANY CATHERINE JUMAILY M.D.

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	208000000X	Pediatrics Physician	258112	MA
2	208000000X	Pediatrics Physician	147000	CA

General Provider Information

NPI Number	:	1437442662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY CATHERINE JUMAILY M.D.

Provider Business Mailing Address
First Line	:	2080 CENTURY PARK E STE 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2006
Country	:	US
Telephone Number	:	310-657-4586
Fax Number	:	310-657-0986

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E STE 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2006
Country	:	US
Telephone Number	:	310-657-4586
Fax Number	:	310-657-0986

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

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	04/01/2019

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