Provider Demographics
NPI:1902085848
Name:ATKINSON, TIFFANY LC (LAC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LC
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24281 JUANENO DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4236
Mailing Address - Country:US
Mailing Address - Phone:949-855-4946
Mailing Address - Fax:
Practice Address - Street 1:34642 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:CAPISTRANO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624-1301
Practice Address - Country:US
Practice Address - Phone:949-489-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11590171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist