Provider Demographics
NPI:1518549187
Name:HOSLEY, TIFFANY SHAVONNE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHAVONNE
Last Name:HOSLEY
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 1:12318 WINDCHIME PL APT E
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3160
Mailing Address - Country:US
Mailing Address - Phone:424-219-2146
Mailing Address - Fax:
Practice Address - Street 1:12318 WINDCHIME PL APT E
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-3160
Practice Address - Country:US
Practice Address - Phone:424-219-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty