Provider Demographics
NPI:1982248753
Name:REPALDA, TIFFANY MARIE (RT)
Entity type:Individual
Prefix:
First Name:TIFFANY MARIE
Middle Name:
Last Name:REPALDA
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 777851
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7851
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:702-893-0960
Practice Address - Street 1:7250 PEAK DRIVE
Practice Address - Street 2:SUITE #118
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-893-3333
Practice Address - Fax:702-665-5170
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NVRC3339227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician