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General NPI Number Information
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NPI Number | 1841705399
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Entity Type | Individual
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Provider Name | DAVID FONSECA TAPIA ATC, EMT
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Gender | Male
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 1350 S ELISEO DR
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City | GREENBRAE
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State | CA
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Zip | 94904-2011
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Country | US
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Telephone | 415-798-0651
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 GLEN COVE PKWY APT 1509
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City | VALLEJO
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State | CA
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Zip | 94591-7177
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Country | US
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Telephone | 661-917-4299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | E2031440
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000036585
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License Number State |
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