Tisha Mallon, L.AC., DIPL.AC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC 4302 Issued in CA

Practice address

21 Tamal Vista Blvd
Corte Madera, CA 94925-1130

Phone

(415) 378-3039

NPI assigned

Apr 2, 2014

Last updated

Dec 18, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Tisha Mallon Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1588082911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 BELLE AVE",
            "city": "FAIRFAX",
            "state": "CA",
            "postal_code": "949301727",
            "telephone_number": "415-378-3039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 TAMAL VISTA BLVD",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251130",
            "telephone_number": "415-378-3039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLON",
        "first_name": "TISHA",
        "name_prefix": "Prof.",
        "credential": "L.AC., DIPL.AC.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-02",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC 4302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.tishamallon.com",
            "affiliation": "N",
            "address_1": "21 Tamal Vista Blvd",
            "city": "Corte Madera",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949251130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "TISHA",
            "last_name": "MALLON",
            "prefix": "MS.",
            "credential": "L.AC., DIPL.AC.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Acupuncturist in Corte Madera, CA
• Providers in Corte Madera, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.