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NPI Code Detail

MEDICARE: TIFFANNY EDELMAN

MEDICARE: TIFFANNY EDELMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-19-108692CO
2106S00000XBehavior Technician21-172097FL

General Provider Information

NPI Number : 1437799624
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANNY EDELMAN
Provider Business Mailing Address
First Line : 18726 S. WESTERN AVENUE SUITE 408
Second Line :
City : GARDENA
State : CA
Zip : 90248
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9405 BARNSTEAD LN
Second Line :
City : PORT RICHEY
State : FL
Zip : 34668-4302
Country : US
Telephone Number : 727-967-2809
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2020
Last Update Date : 05/09/2022

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Directions to “ TIFFANNY EDELMAN ” Practice Location

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