Healthcare Provider Details

I. General information

NPI: 1396479457
Provider Name (Legal Business Name): TIFFANY SHIFFON BRIGGS BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY SHIFFON BRIGGS BACHELORS DEGREE

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 09/29/2026
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 W 190TH ST STE 220
GARDENA CA
90248-4321
US

IV. Provider business mailing address

1149 W 190TH ST STE 2200
GARDENA CA
90248-4344
US

V. Phone/Fax

Practice location:
  • Phone: 310-856-0800
  • Fax: 855-568-2494
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: