Active NPI
Tiffany Johnson
- School Psychologist
- Vallejo, CA
National Provider Identifier
1104593771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 2833 Tennessee St
Vallejo, CA 94591-4948 - Phone
- (707) 556-8620
- NPI assigned
- Aug 23, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | Primary |
Addresses
Primary practice location
2833 Tennessee St
Vallejo, CA 94591-4948
Mailing address
3093 Broadway Unit 432
Oakland, CA 94611-5791
Phone (805) 286-8436
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629676800000",
"number": "1104593771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3093 BROADWAY UNIT 432",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946115791",
"telephone_number": "805-286-8436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2833 TENNESSEE ST",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945914948",
"telephone_number": "707-556-8620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "TIFFANY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-23",
"last_updated": "2021-08-23",
"certification_date": "2021-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.