Healthcare Provider Details

I. General information

NPI: 1477507879
Provider Name (Legal Business Name): DAVID A. TUFENKIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E HICKORY AVE
LOMPOC CA
93436-7337
US

IV. Provider business mailing address

365 VEREDA DEL CIERVO
GOLETA CA
93117-5305
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-3333
  • Fax:
Mailing address:
  • Phone: 805-685-8689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG58142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: