Healthcare Provider Details

I. General information

NPI: 1417914268
Provider Name (Legal Business Name): BERTHA F TSAI-TULAGAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6942 UNIVERSITY AVE STE A
LA MESA CA
91942
US

IV. Provider business mailing address

6942 UNIVERSITY AVE STE A
LA MESA CA
91942-5963
US

V. Phone/Fax

Practice location:
  • Phone: 619-698-2184
  • Fax:
Mailing address:
  • Phone: 619-698-2184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number34.008124
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A9673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: