Healthcare Provider Details

I. General information

NPI: 1376842864
Provider Name (Legal Business Name): TIFFANY H. AMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 JACKSON ST STE 207
RIVERSIDE CA
92503-3901
US

IV. Provider business mailing address

3975 JACKSON ST STE 207
RIVERSIDE CA
92503-3901
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-2092
  • Fax: 951-352-1913
Mailing address:
  • Phone: 951-352-2092
  • Fax: 951-352-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA128438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: