Provider Demographics
NPI:1659063824
Name:OLAIRES, TIFFANI (RD)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:
Last Name:OLAIRES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:TIFFANI
Other - Middle Name:
Other - Last Name:LAMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:781 VICTORIAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7137
Mailing Address - Country:US
Mailing Address - Phone:949-769-1197
Mailing Address - Fax:
Practice Address - Street 1:111 RALEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8351
Practice Address - Country:US
Practice Address - Phone:530-332-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86276018133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered