Provider Demographics
NPI:1710307434
Name:MUJAHED, TIFFANY PRISCILLA JANE (DPT)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:PRISCILLA JANE
Last Name:MUJAHED
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:PRISCILLA JANE
Other - Last Name:MICHELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2320 CALLE REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4231
Mailing Address - Country:US
Mailing Address - Phone:805-687-8553
Mailing Address - Fax:805-687-5325
Practice Address - Street 1:2320 CALLE REAL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4231
Practice Address - Country:US
Practice Address - Phone:805-687-8553
Practice Address - Fax:805-687-5325
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist