Individual
TIFFANY ROCHELLE FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
2504 3RD AVE, MERCED, CA 95340-3010
(209) 720-9380
Mailing address
PO BOX 3183, MERCED, CA 95344-1183
(209) 535-0950
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
700251
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700251
RBT
CA
Enumeration date
09/15/2022
Last updated
09/15/2022
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