Provider Demographics
NPI:1982127288
Name:YONEMOTO, TIFFANY CHIYEKO (CTRS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHIYEKO
Last Name:YONEMOTO
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:CHIYEKO
Other - Last Name:YOSHIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:7601 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3456
Mailing Address - Country:US
Mailing Address - Phone:562-385-6322
Mailing Address - Fax:
Practice Address - Street 1:7601 E. IMPERIAL HWY.
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242
Practice Address - Country:US
Practice Address - Phone:562-385-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60240225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist