Healthcare Provider Details

I. General information

NPI: 1144455668
Provider Name (Legal Business Name): DAVID TAFOLLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 HUGHSON AVE.
HUGHSON CA
95326-0264
US

IV. Provider business mailing address

PO BOX 264 6940 HUGHSON AVE.
HUGHSON CA
95326-0264
US

V. Phone/Fax

Practice location:
  • Phone: 209-883-2027
  • Fax:
Mailing address:
  • Phone: 209-883-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: