Provider Demographics
NPI:1346973567
Name:WASHINGTON, TIFFANY (RN, IBCLC)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5761 KINGMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2013
Mailing Address - Country:US
Mailing Address - Phone:714-293-5841
Mailing Address - Fax:
Practice Address - Street 1:800 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1809
Practice Address - Country:US
Practice Address - Phone:714-293-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95057750163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty