Healthcare Provider Details

I. General information

NPI: 1083172886
Provider Name (Legal Business Name): TIFFANY ELIZABETH PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77564 COUNTRY CLUB DR STE 340
PALM DESERT CA
92211-0450
US

IV. Provider business mailing address

77564 COUNTRY CLUB DR STE 340
PALM DESERT CA
92211-0450
US

V. Phone/Fax

Practice location:
  • Phone: 760-772-2838
  • Fax:
Mailing address:
  • Phone: 760-772-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: