Provider Demographics
NPI:1518320084
Name:STROMBERG, TIFFANY LUCILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LUCILLE
Last Name:STROMBERG
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 1:725 WELCH RD
Mailing Address - Street 2:MC 4906
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-497-8979
Mailing Address - Fax:650-497-8228
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:MC 4906
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8979
Practice Address - Fax:650-497-8228
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0195208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program