Healthcare Provider Details

I. General information

NPI: 1710840145
Provider Name (Legal Business Name): TIFFANI NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 ARNOLD RD STE 100
DUBLIN CA
94568-7726
US

IV. Provider business mailing address

1969 EVELETH AVE
SAN LEANDRO CA
94577-3316
US

V. Phone/Fax

Practice location:
  • Phone: 925-462-2281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: