Provider Demographics
NPI:1932398385
Name:MCENTIRE, TIFFINIE PAULETTE (MS, LAC)
Entity Type:Individual
Prefix:
First Name:TIFFINIE
Middle Name:PAULETTE
Last Name:MCENTIRE
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 LOMBARD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2828
Mailing Address - Country:US
Mailing Address - Phone:415-673-6378
Mailing Address - Fax:
Practice Address - Street 1:1990 LOMBARD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2828
Practice Address - Country:US
Practice Address - Phone:415-673-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11483171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist