Healthcare Provider Details

I. General information

NPI: 1730470337
Provider Name (Legal Business Name): TIFFANY DAMIKOLAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY CRUNELLE

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 S BRISTOL ST STE 110
SANTA ANA CA
92704-6210
US

IV. Provider business mailing address

2040 CAMFIELD AVE
COMMERCE CA
90040-1574
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-6343
  • Fax:
Mailing address:
  • Phone: 888-499-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA123666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: