Provider Demographics
NPI:1093905580
Name:GLASS, TIFFANY DANIELLE
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:DANIELLE
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1452
Mailing Address - Country:US
Mailing Address - Phone:916-736-0828
Mailing Address - Fax:
Practice Address - Street 1:4545 9TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1452
Practice Address - Country:US
Practice Address - Phone:916-736-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator