Healthcare Provider Details

I. General information

NPI: 1932077815
Provider Name (Legal Business Name): TIFFANY VERONICA SMITH CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 S BOND AVE
PORTLAND OR
97239-4838
US

IV. Provider business mailing address

3850 S BOND AVE APT 525
PORTLAND OR
97239-4837
US

V. Phone/Fax

Practice location:
  • Phone: 949-449-9175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number187183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: