Healthcare Provider Details

I. General information

NPI: 1245194695
Provider Name (Legal Business Name): TIFFANY R STAFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25477 PLUMERIA LN
MORENO VALLEY CA
92551-2562
US

IV. Provider business mailing address

25477 PLUMERIA LN
MORENO VALLEY CA
92551-2562
US

V. Phone/Fax

Practice location:
  • Phone: 951-417-9006
  • Fax:
Mailing address:
  • Phone: 951-417-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: