Healthcare Provider Details

I. General information

NPI: 1275558413
Provider Name (Legal Business Name): TIFFANY CAROL WOHLWEND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 TWIN CITIES RD SUITE 20-114
GALT CA
95632-9033
US

IV. Provider business mailing address

10400 TWIN CITIES RD SUITE 20-114
GALT CA
95632-9033
US

V. Phone/Fax

Practice location:
  • Phone: 530-219-2298
  • Fax: 925-225-5838
Mailing address:
  • Phone: 530-219-2298
  • Fax: 925-225-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 17650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: