Healthcare Provider Details

I. General information

NPI: 1992923056
Provider Name (Legal Business Name): MR. PHILLIP TAPIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SOUTH E STREET SUITE 200
SANTA ROSA CA
95404
US

IV. Provider business mailing address

555 NORTHGATE DR STE 200
SAN RAFAEL CA
94903-3696
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-8452
  • Fax: 707-571-5531
Mailing address:
  • Phone: 415-457-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: