Provider Demographics
NPI:1154060788
Name:TIFFANY, CARA CHRISTINE
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:CHRISTINE
Last Name:TIFFANY
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 1:30597 RED CLOUD WAY
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-2649
Mailing Address - Country:US
Mailing Address - Phone:562-240-9417
Mailing Address - Fax:
Practice Address - Street 1:30597 RED CLOUD WAY
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-2649
Practice Address - Country:US
Practice Address - Phone:562-240-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician