Provider Demographics
NPI:1629243670
Name:OMEARA, TIFFANY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:OMEARA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DRIVE
Mailing Address - Street 2:#0304
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0304
Mailing Address - Country:US
Mailing Address - Phone:858-534-1579
Mailing Address - Fax:858-534-2628
Practice Address - Street 1:9500 GILMAN DRIVE
Practice Address - Street 2:#0304
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0304
Practice Address - Country:US
Practice Address - Phone:858-534-1579
Practice Address - Fax:858-534-2628
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19062103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling