Provider Demographics
NPI:1376088161
Name:CABUTAGE, TIFFANI (CR)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:CABUTAGE
Suffix:
Gender:F
Credentials:CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAPLE ST STE G
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3249
Mailing Address - Country:US
Mailing Address - Phone:408-569-3961
Mailing Address - Fax:
Practice Address - Street 1:11 MAPLE ST STE G
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3249
Practice Address - Country:US
Practice Address - Phone:408-569-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79566225700000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist