Provider Demographics
NPI:1700312493
Name:AFIFI, TINA PAGE (HA7576)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:PAGE
Last Name:AFIFI
Suffix:
Gender:F
Credentials:HA7576
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1111 SONOMA AVE
Mailing Address - Street 2:STE 316
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4819
Mailing Address - Country:US
Mailing Address - Phone:707-523-4740
Mailing Address - Fax:707-523-0231
Practice Address - Street 1:1111 SONOMA AVE
Practice Address - Street 2:STE 316
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4819
Practice Address - Country:US
Practice Address - Phone:707-523-4740
Practice Address - Fax:707-523-0231
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7576237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist