Healthcare Provider Details

I. General information

NPI: 1346545894
Provider Name (Legal Business Name): TIFFANY ROSE GHATAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 ROSECRANS AVE
BELLFLOWER CA
90706-2246
US

IV. Provider business mailing address

9400 ROSECRANS AVE
BELLFLOWER CA
90706-2246
US

V. Phone/Fax

Practice location:
  • Phone: 562-461-5470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A11512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: