MEDICARE: TIFFANY BEATE VALLENDER RN

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
1	163WC0400X	Case Management Registered Nurse	95313665	CA

General Provider Information

NPI Number	:	1578249439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY BEATE VALLENDER RN

Provider Business Mailing Address
First Line	:	601 12TH STREET SUITE 1600
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 CALAVERAS RD #720360
Second Line	:
City	:	PINON HILLS
State	:	CA
Zip	:	92372
Country	:	US
Telephone Number	:	734-474-2704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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