Healthcare Provider Details

I. General information

NPI: 1770661670
Provider Name (Legal Business Name): MARTHA F. TAPIA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 WELLNESS WAY
VALLEY SPRINGS CA
95252-9736
US

IV. Provider business mailing address

51 WELLNESS WAY
VALLEY SPRINGS CA
95252-9736
US

V. Phone/Fax

Practice location:
  • Phone: 209-772-7070
  • Fax:
Mailing address:
  • Phone: 209-772-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0058024
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A7804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: