Provider Demographics
NPI:1225433501
Name:TIFERES MEDICAL GROUP
Entity Type:Organization
Organization Name:TIFERES MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TEBEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-704-3168
Mailing Address - Street 1:1020 CORPORATION WAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4328
Mailing Address - Country:US
Mailing Address - Phone:650-704-1867
Mailing Address - Fax:
Practice Address - Street 1:1020 CORPORATION WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4328
Practice Address - Country:US
Practice Address - Phone:650-704-1867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15375261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center