Active NPI
Tiffany Blackham, HBCE, CD
- Doula
- Costa Mesa, CA
National Provider Identifier
1003708033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Doula
- License
- 4570
- Practice address
- 1525 Mesa Verde Dr E Ste 210
Costa Mesa, CA 92626-5219 - Phone
- (702) 205-6073
- NPI assigned
- Jul 15, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Doula | 374J00000X | 4570 | CA | Primary |
Addresses
Primary practice location
1525 Mesa Verde Dr E Ste 210
Costa Mesa, CA 92626-5219
Mailing address
5751 S Pearl St
Las Vegas, NV 89120-2509
Phone (702) 205-6073
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4570 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752537600000",
"number": "1003708033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5751 S PEARL ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891202509",
"telephone_number": "702-205-6073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 MESA VERDE DR E STE 210",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926265219",
"telephone_number": "702-205-6073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKHAM",
"first_name": "TIFFANY",
"credential": "HBCE, CD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-07-15",
"last_updated": "2025-07-15",
"certification_date": "2025-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": "CA",
"license": "4570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.