Provider Demographics
NPI:1609149384
Name:MARTINEZ, TIFFANY TAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TAM
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40420 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6400
Mailing Address - Country:US
Mailing Address - Phone:951-698-7459
Mailing Address - Fax:951-698-8097
Practice Address - Street 1:40420 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-6400
Practice Address - Country:US
Practice Address - Phone:951-698-7459
Practice Address - Fax:951-698-8097
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist