Provider Demographics
NPI:1053638601
Name:TIFFANY ANDERSON TERRELL, DO. INC
Entity Type:Organization
Organization Name:TIFFANY ANDERSON TERRELL, DO. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-548-4900
Mailing Address - Street 1:13193 CENTRAL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4179
Mailing Address - Country:US
Mailing Address - Phone:909-548-4900
Mailing Address - Fax:909-548-4904
Practice Address - Street 1:5253 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4151
Practice Address - Country:US
Practice Address - Phone:909-464-2845
Practice Address - Fax:909-464-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8506261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center