Provider Demographics
NPI:1770542664
Name:KINGSBURY, TIFFANY LAINE (TECHNICIANS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LAINE
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:TECHNICIANS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USCG HQ COMDT (CG-1122)
Mailing Address - Street 2:2100 SECOND ST., SW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:202-475-5181
Mailing Address - Fax:202-475-5909
Practice Address - Street 1:1 EAGLE RD BLDG 1
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5100
Practice Address - Country:US
Practice Address - Phone:510-437-3582
Practice Address - Fax:510-437-3300
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians