Individual
TIFFANY D MAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 E SANTA CLARA ST, SAN JOSE, CA 95113-1936
(669) 245-3428
Mailing address
425 E SANTA CLARA ST, SAN JOSE, CA 95113-1936
(669) 245-3428
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
CA
175T00000X
Peer Specialist
Primary
MPSS-FNWJQK
CA
Other
Enumeration date
05/02/2024
Last updated
06/02/2026
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