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General NPI Number Information
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NPI Number | 1285597831
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Entity Type | Individual
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Provider Name | TIFFANY GILLIS
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Gender | Female
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 100 AVENIDA SAN DIMAS
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3421
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Country | US
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Telephone | 949-354-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 33601 RISING TIDE CT
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City | DANA POINT
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State | CA
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Zip | 92629-1924
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Country | US
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Telephone | 949-354-1020
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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 | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number |
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License Number State |
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