Healthcare Provider Details

I. General information

NPI: 1982248753
Provider Name (Legal Business Name): TIFFANY MARIE REPALDA RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 PEAK DRIVE SUITE #118
LAS VEGAS NV
89128
US

IV. Provider business mailing address

P.O. BOX 777851
HENDERSON NV
89077-7851
US

V. Phone/Fax

Practice location:
  • Phone: 702-893-3333
  • Fax: 702-665-5170
Mailing address:
  • Phone: 702-893-3333
  • Fax: 702-893-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRC3339
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: