Healthcare Provider Details

I. General information

NPI: 1043721020
Provider Name (Legal Business Name): TIFFANY RAE LAIRD RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 01/07/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ARNOLD DR STE 200
MARTINEZ CA
94553-4189
US

IV. Provider business mailing address

2400 BISSO LN STE D1
CONCORD CA
94520-4832
US

V. Phone/Fax

Practice location:
  • Phone: 925-957-5150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number844787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: