Tiffany Renee Agra

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

103693 Issued in CA

Practice address

23832 Rockfield Blvd Ste 120
Lake Forest, CA 92630-2870

Phone

(949) 767-6396

NPI assigned

Jan 13, 2010

Last updated

Jul 31, 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

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": "1263340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1770813743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23832 ROCKFIELD BLVD STE 120",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302870",
            "telephone_number": "949-767-6396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23832 ROCKFIELD BLVD STE 120",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302870",
            "telephone_number": "949-767-6396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGRA",
        "first_name": "TIFFANY",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-13",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "103693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.