Provider Demographics
NPI:1982949343
Name:SANI, TIFFANY D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:D
Last Name:SANI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N SWALL DR
Mailing Address - Street 2:PH8
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6807
Mailing Address - Country:US
Mailing Address - Phone:818-314-1414
Mailing Address - Fax:
Practice Address - Street 1:128 N SWALL DR
Practice Address - Street 2:PH8
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6807
Practice Address - Country:US
Practice Address - Phone:818-314-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20994103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical