1679325229 NPI number — WONISHIA TIFFANY ROYAL

Table of content: WONISHIA TIFFANY ROYAL (NPI 1679325229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679325229 NPI number — WONISHIA TIFFANY ROYAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROYAL
Provider First Name:
WONISHIA
Provider Middle Name:
TIFFANY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679325229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 STATE ST APT 84
Provider Second Line Business Mailing Address:
867 N FAIR OAKS AVE, PASADENA, CA 91103
Provider Business Mailing Address City Name:
SOUTH PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91030-2128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-797-6793
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
867 N FAIR OAKS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91103-3050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-798-6793
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 373H00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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