Provider Demographics
NPI:1699098285
Name:FRALEY, TIFFANY N
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:N
Last Name:FRALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:N
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57407 TWENTYNINE PALMS HIGHWAY
Mailing Address - Street 2:SUITE F
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284
Mailing Address - Country:US
Mailing Address - Phone:760-366-1541
Mailing Address - Fax:760-228-1614
Practice Address - Street 1:57407 TWENTYNINE PALMS HIGHWAY
Practice Address - Street 2:SUITE F
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:760-366-1541
Practice Address - Fax:760-228-1614
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program