MEDICARE: KARLA GABRIELLE TAPIA PA-C

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	363A00000X	Physician Assistant	085005970	IL

General Provider Information

NPI Number	:	1598216368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA GABRIELLE TAPIA PA-C

Provider Business Mailing Address
First Line	:	2840 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2938
Country	:	US
Telephone Number	:	773-292-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2938
Country	:	US
Telephone Number	:	773-292-6250
Fax Number	:

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	04/30/2021

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