Provider Demographics
NPI:1851679336
Name:HOGAN, TIFFANY ALINE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ALINE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24708 GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4960
Mailing Address - Country:US
Mailing Address - Phone:949-322-4562
Mailing Address - Fax:
Practice Address - Street 1:24708 GARLAND DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4960
Practice Address - Country:US
Practice Address - Phone:949-322-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine