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General NPI Number Information
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NPI Number | 1093446957
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Entity Type | Individual
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Provider Name | MARY TIFFANY CERENECHE NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 333 THALIA ST
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2713
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Country | US
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Telephone | 949-499-0577
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Fax |
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Provider Business Mailing Address
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Address Line | 25 SILKBERRY
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City | IRVINE
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State | CA
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Zip | 92614-7480
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Country | US
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Telephone | 757-618-3763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NP95019956
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License Number State | CA
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