Provider Demographics
NPI:1902689441
Name:SEGURA, TIFFANY NGUYEN (DPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NGUYEN
Last Name:SEGURA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:NGUYEN
Other - Last Name:RACZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5190 SHADOW EST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1229
Mailing Address - Country:US
Mailing Address - Phone:714-330-1599
Mailing Address - Fax:
Practice Address - Street 1:5190 SHADOW EST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1229
Practice Address - Country:US
Practice Address - Phone:714-330-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist