Basic Information
| Provider Information | |||||||||
| NPI: | 1891358313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLURE | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 TREAT BLVD # 300 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945972168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259522855 | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 BROOKWOOD RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | ORINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945633047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252549090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2019 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | A177743 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.