| NPI | 1891238465 |
|---|---|
| Former Name | TIFFANY ILANA GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54036) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 54036) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA 54036) | |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2017-07-07 |