Provider Demographics
NPI:1396081808
Name:GONZALES, TIFFANIE CHRISTEEN (CPM CLC)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:CHRISTEEN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CPM CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 S EASTERN AVE STE 9A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3153
Mailing Address - Country:US
Mailing Address - Phone:702-448-9428
Mailing Address - Fax:
Practice Address - Street 1:8826 S EASTERN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4824
Practice Address - Country:US
Practice Address - Phone:702-448-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife