Individual
DR. CANDICE TIFFANY MYHRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4650 LINCOLN BLVD, DANIEL FREEMAN MARINA HOSPITAL ED, MARINA DEL REY, CA 90292
(310) 822-6005
Mailing address
201 44TH STREET, MANHATTAN BEACH, CA 90266
(310) 944-2623
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A789420
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A789420
BLUE SHIELD
—
05
—
00A789420
—
CA
Enumeration date
05/11/2006
Last updated
05/21/2008
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