Provider Demographics
NPI:1861786642
Name:JONSSON, TIFFANY M (LAC)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:M
Last Name:JONSSON
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 1:802 1/4 SUTTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3920
Mailing Address - Country:US
Mailing Address - Phone:619-995-3337
Mailing Address - Fax:
Practice Address - Street 1:1281 UNIVERSITY AVE STE E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7305
Practice Address - Country:US
Practice Address - Phone:619-995-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14250171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist