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General NPI Number Information
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NPI Number | 1972086882
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Entity Type | Organization
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Legal Business Name | TAGALOA-TULIFAU FOOT AND ANKLE CENTER, INC.
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 5220 CLARK AVE STE 315
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City | LAKEWOOD
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State | CA
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Zip | 90712-2635
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Country | US
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Telephone | 562-925-3055
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Fax | 562-925-7371
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Provider Business Mailing Address
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Address Line | 5220 CLARK AVE STE 315
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City | LAKEWOOD
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State | CA
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Zip | 90712-2635
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Country | US
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Telephone | 562-925-3055
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Fax | 562-925-7371
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MAFUTAGA TAGALOA-TULIFAU
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Credential | D.P.M.
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Telephone | 562-925-3055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4193
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License Number State | CA
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