Individual
TIFFANY MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPO
Contact information
Practice address
1920 E KATELLA AVE STE I, ORANGE, CA 92867-5149
(714) 639-7422
Mailing address
1920 E KATELLA AVE STE I, ORANGE, CA 92867-5149
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CPO1893
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518909019
MEDI-CAL
CA
Enumeration date
07/08/2021
Last updated
07/08/2021
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