Healthcare Provider Details

I. General information

NPI: 1689583387
Provider Name (Legal Business Name): TIFFANY DAWN MORAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 W HARRIS ST
EUREKA CA
95503-3927
US

IV. Provider business mailing address

1480 CAMINO WAY
MCKINLEYVILLE CA
95519-8042
US

V. Phone/Fax

Practice location:
  • Phone: 707-805-7179
  • Fax:
Mailing address:
  • Phone: 808-845-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: