Provider Demographics
NPI:1912099557
Name:KAUFMAN-SCANNA, TIFFANY SHILA (PA C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHILA
Last Name:KAUFMAN-SCANNA
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31002 STRAWBERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4181
Mailing Address - Country:US
Mailing Address - Phone:407-902-6979
Mailing Address - Fax:
Practice Address - Street 1:24910 LAS BRISAS RD STE 105
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4010
Practice Address - Country:US
Practice Address - Phone:951-231-1385
Practice Address - Fax:866-345-3272
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20229363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41517ZMedicare ID - Type Unspecified
Q01049Medicare UPIN