Provider Demographics
NPI:1932630431
Name:HSU, TIFFANY (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:HSU
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 S FERNTOWER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3215
Mailing Address - Country:US
Mailing Address - Phone:909-802-8332
Mailing Address - Fax:
Practice Address - Street 1:3848 S FERNTOWER AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3215
Practice Address - Country:US
Practice Address - Phone:909-802-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86053751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered