Provider Demographics
NPI:1376437608
Name:THOMAS-DOUGLAS, TIFFANY SHENA
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHENA
Last Name:THOMAS-DOUGLAS
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 1:1330 ARNOLD DR STE 142
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6538
Mailing Address - Country:US
Mailing Address - Phone:925-405-7175
Mailing Address - Fax:
Practice Address - Street 1:1330 ARNOLD DR STE 142
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-6538
Practice Address - Country:US
Practice Address - Phone:925-665-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist