Provider Demographics
NPI:1043932262
Name:CAMPBELL KALOUSTIAN, TIFFANY MALIA LOKELANI (MED, BED, INHC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MALIA LOKELANI
Last Name:CAMPBELL KALOUSTIAN
Suffix:
Gender:F
Credentials:MED, BED, INHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13136 VISTA VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4486
Mailing Address - Country:US
Mailing Address - Phone:818-414-9090
Mailing Address - Fax:
Practice Address - Street 1:13136 VISTA VIEW CIR
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4486
Practice Address - Country:US
Practice Address - Phone:818-414-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171400000XOther Service ProvidersHealth & Wellness Coach