Individual
TIFFANY RENEE ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1007 N LAKE AVE, PASADENA, CA 91104-4521
(626) 808-9746
Mailing address
130 E WASHINGTON BLVD APT 3, PASADENA, CA 91103-2287
(626) 797-4838
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT37093
CA
Other
Enumeration date
09/12/2013
Last updated
09/12/2013
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