MEDICARE: TIFFANY AMBER MCWILLIAMSS

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	225700000X	Massage Therapist	61458	CA

General Provider Information

NPI Number	:	1780514471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY AMBER MCWILLIAMSS

Provider Business Mailing Address
First Line	:	1778 SINALOA RD APT 295
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-3076
Country	:	US
Telephone Number	:	805-815-1201
Fax Number	:

Provider Business Practice Location Address
First Line	:	1778 SINALOA RD APT 295
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-3076
Country	:	US
Telephone Number	:	805-815-1201
Fax Number	:

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

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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