Healthcare Provider Details

I. General information

NPI: 1073427027
Provider Name (Legal Business Name): JOHN D TAFOLLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LAKEWAY DR
BELLINGHAM WA
98225-5236
US

IV. Provider business mailing address

3449 REDWOOD AVE APT 2
BELLINGHAM WA
98225-1166
US

V. Phone/Fax

Practice location:
  • Phone: 360-676-6749
  • Fax: 360-738-2451
Mailing address:
  • Phone: 360-676-6749
  • Fax: 360-738-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCAAR.CG.70150774
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: