Provider Demographics
NPI:1699489609
Name:GARCIA, TIFFANY JANE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JANE
Last Name:GARCIA
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 1:295 NESMITH RD
Mailing Address - Street 2:
Mailing Address - City:RICKREALL
Mailing Address - State:OR
Mailing Address - Zip Code:97371-1103
Mailing Address - Country:US
Mailing Address - Phone:503-510-2456
Mailing Address - Fax:
Practice Address - Street 1:305 NESMITH RD
Practice Address - Street 2:
Practice Address - City:RICKREALL
Practice Address - State:OR
Practice Address - Zip Code:97371-1104
Practice Address - Country:US
Practice Address - Phone:503-510-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education