Healthcare Provider Details

I. General information

NPI: 1396081808
Provider Name (Legal Business Name): TIFFANIE CHRISTEEN GONZALES CPM CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8826 S EASTERN AVE SUITE 110
LAS VEGAS NV
89123-4824
US

IV. Provider business mailing address

6000 S EASTERN AVE STE 9A
LAS VEGAS NV
89119-3153
US

V. Phone/Fax

Practice location:
  • Phone: 702-448-9428
  • Fax:
Mailing address:
  • Phone: 702-448-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: