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General NPI Number Information
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NPI Number | 1891144580
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Entity Type | Individual
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Provider Name | TIFFANY LYNN MATHIAS MD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 6350 W RAMSEY ST STE Q
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City | BANNING
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State | CA
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Zip | 92220-3066
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Country | US
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Telephone | 951-490-4910
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Fax |
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Provider Business Mailing Address
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Address Line | 230 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1121
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Country | US
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Telephone | 215-762-2632
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A161559
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MT211248
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License Number State | PA
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