Healthcare Provider Details

I. General information

NPI: 1710909643
Provider Name (Legal Business Name): CHARLES F. TUFFLI JR M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 FOREST AVE SUITE 101
SAN JOSE CA
95128-1422
US

IV. Provider business mailing address

2100 FOREST AVE SUITE 101
SAN JOSE CA
95128-1422
US

V. Phone/Fax

Practice location:
  • Phone: 408-286-6900
  • Fax: 408-286-6917
Mailing address:
  • Phone: 408-286-6900
  • Fax: 408-286-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG021128
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES FREDERICK TUFFLI JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 408-286-6900