Individual
TIFFANY PHALAVISAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RRT
Contact information
Practice address
9377 DAUCHY AVE, RIVERSIDE, CA 92508-9346
(909) 561-2154
Mailing address
9377 DAUCHY AVE, RIVERSIDE, CA 92508-9346
(909) 561-2154
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
40995
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20170500094900
—
CA
Enumeration date
12/08/2020
Last updated
12/08/2020
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