Individual provider Active NPI

Tiffany P Zaken, PA-C

  • Medical Physician Assistant
  • Brea, CA
National Provider Identifier
1780228445
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
2864 E Imperial Hwy
Brea, CA 92821-6714
Phone
(714) 996-9708
Fax
(714) 996-1230
NPI assigned
Nov 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

2864 E Imperial Hwy
Brea, CA 92821-6714

Mailing address

2864 E Imperial Hwy
Brea, CA 92821
Phone (714) 996-9708

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200828001052 CA Order and Referring Only - Physician Assistant 2163849639

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
57726CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Complete Care Medical Group Professional Corporation PastSince Jun 1, 2023 Accepting new patients
Felice L. Gersh, M.D., Inc. PastSince Nov 1, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1780228445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2864 E IMPERIAL HWY",
            "city": "BREA",
            "state": "CA",
            "postal_code": "92821",
            "telephone_number": "714-996-9708",
            "fax_number": "714-996-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2864 E IMPERIAL HWY",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928216714",
            "telephone_number": "714-996-9708",
            "fax_number": "714-996-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAKEN",
        "first_name": "TIFFANY",
        "middle_name": "P",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-05",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brea, CA

Sources for this page

Verify at the official NPI Registry.