Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A77101 | CA |
N | 207PE0004X | Emergency Medical Services | A77101 | CA |
NPI | 1003986415 |
---|---|
Provider Name | Dr. Tiffany Hackett |
First Address | Los Angeles, CA 90051-5558 |
Second Address | Los Angeles, CA 90048-1865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H93573 | (02) | CA |