Provider Demographics
NPI:1194576801
Name:GILLIES, TIFFANY (IBCLC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GILLIES
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 ATAKAPA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5389
Mailing Address - Country:US
Mailing Address - Phone:661-496-9896
Mailing Address - Fax:
Practice Address - Street 1:10415 ATAKAPA AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-5389
Practice Address - Country:US
Practice Address - Phone:661-496-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-302719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist