Healthcare Provider Details

I. General information

NPI: 1033628359
Provider Name (Legal Business Name): TIFFANY CHANCE IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18925 OCEAN PARK LN
HUNTINGTON BEACH CA
92648-6068
US

IV. Provider business mailing address

18925 OCEAN PARK LN
HUNTINGTON BEACH CA
92648-6068
US

V. Phone/Fax

Practice location:
  • Phone: 714-483-5970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: