Provider Demographics
NPI:1437442662
Name:JUMAILY, TIFFANY CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CATHERINE
Last Name:JUMAILY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E STE 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2006
Mailing Address - Country:US
Mailing Address - Phone:310-657-4586
Mailing Address - Fax:310-657-0986
Practice Address - Street 1:2080 CENTURY PARK E STE 305
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2006
Practice Address - Country:US
Practice Address - Phone:310-657-4586
Practice Address - Fax:310-657-0986
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258112208000000X
CA147000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics