Provider Demographics
NPI:1801127600
Name:TIFFT, TAMARA KAY (LAC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:TIFFT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PALOMA AVE
Mailing Address - Street 2:6
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2417
Mailing Address - Country:US
Mailing Address - Phone:310-384-7738
Mailing Address - Fax:
Practice Address - Street 1:45 PALOMA AVE
Practice Address - Street 2:6
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2417
Practice Address - Country:US
Practice Address - Phone:310-384-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10813171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist