Provider Demographics
NPI:1497412266
Name:JASSO, TIFFANY (RADT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:JASSO
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BERNAL RD STE 70
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1375
Mailing Address - Country:US
Mailing Address - Phone:408-281-6560
Mailing Address - Fax:408-281-6564
Practice Address - Street 1:9505 MALECH RD
Practice Address - Street 2:PARISI HOUSE ON THE HILL
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138
Practice Address - Country:US
Practice Address - Phone:408-281-6560
Practice Address - Fax:408-281-6564
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1252580517101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)