Healthcare Provider Details

I. General information

NPI: 1104601509
Provider Name (Legal Business Name): TIFFANY ELIZABETH RAMIREZ REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY ELIZABETH LAHUE REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST STE A
MODESTO CA
95350-5814
US

IV. Provider business mailing address

500 N 9TH ST STE A
MODESTO CA
95350-5814
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-5300
  • Fax: 209-558-4586
Mailing address:
  • Phone: 209-525-5300
  • Fax: 209-558-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95166691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: