Provider Demographics
NPI:1619424413
Name:LOIURIO, TIFFANY ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:LOIURIO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 BOUNDARY ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3833
Mailing Address - Country:US
Mailing Address - Phone:619-929-1232
Mailing Address - Fax:
Practice Address - Street 1:260 E CHASE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6325
Practice Address - Country:US
Practice Address - Phone:619-647-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT16338171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor