Provider Demographics
NPI:1760833081
Name:WAMBUA, TIFFANY (BCBA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WAMBUA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:HAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1526 BROOKHOLLOW DR
Mailing Address - Street 2:#70
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5421
Mailing Address - Country:US
Mailing Address - Phone:866-727-8274
Mailing Address - Fax:
Practice Address - Street 1:1526 BROOKHOLLOW DR
Practice Address - Street 2:#70
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5421
Practice Address - Country:US
Practice Address - Phone:866-727-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-22521103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst