Provider Demographics
NPI:1568265890
Name:MEJIA, TIFFANY FAYRENE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:FAYRENE
Last Name:MEJIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:FAYRENE
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5413 BUFFALO CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-9028
Mailing Address - Country:US
Mailing Address - Phone:510-258-7428
Mailing Address - Fax:
Practice Address - Street 1:300 E LELAND RD STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4961
Practice Address - Country:US
Practice Address - Phone:510-258-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program