MEDICARE: PETER TAPIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146N00000X	Basic Emergency Medical Technician	E041865	CA

General Provider Information

NPI Number	:	1306207717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER TAPIA

Provider Business Mailing Address
First Line	:	PO BOX 833
Second Line	:
City	:	PENNGROVE
State	:	CA
Zip	:	94951-0833
Country	:	US
Telephone Number	:	415-722-8876
Fax Number	:	707-528-3007

Provider Business Practice Location Address
First Line	:	3295 MOORLAND AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-7841
Country	:	US
Telephone Number	:	415-722-8876
Fax Number	:	707-528-3007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	03/11/2016

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Directions to “ PETER TAPIA ” Practice Location

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