Provider Demographics
NPI:1497375117
Name:COOPER, TIFFANY (APCC, MA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:APCC, MA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20695 S WESTERN AVE STE 132
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1834
Mailing Address - Country:US
Mailing Address - Phone:323-334-9000
Mailing Address - Fax:323-334-4437
Practice Address - Street 1:2116 ARLINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1353
Practice Address - Country:US
Practice Address - Phone:323-334-9000
Practice Address - Fax:323-334-4437
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA15777225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator