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General NPI Number Information
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NPI Number | 1376232850
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Entity Type | Individual
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Provider Name | TIFFANY CHEROND NICOLE THOMAS
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Gender | Female
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 2151 W GRANT LINE RD
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City | TRACY
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State | CA
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Zip | 95377-7309
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Country | US
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Telephone | 209-820-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CHARLES ST
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City | TRACY
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State | CA
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Zip | 95376-1329
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Country | US
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Telephone | 209-640-2454
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 120293
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License Number State | CA
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