Provider Demographics
NPI:1225465735
Name:THOMAS, TIFFANY M (CSA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 FARREL HILL ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-7071
Mailing Address - Country:US
Mailing Address - Phone:832-724-7048
Mailing Address - Fax:
Practice Address - Street 1:3410 FARREL HILL ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-7071
Practice Address - Country:US
Practice Address - Phone:832-724-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4053246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist