MEDICARE: TAGALOA-TULIFAU FOOT AND ANKLE CENTER, INC.

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1679390066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAGALOA-TULIFAU FOOT AND ANKLE CENTER, INC.

Provider Business Mailing Address
First Line	:	23517 MAIN ST STE 105
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-5236
Country	:	US
Telephone Number	:	424-450-0950
Fax Number	:	562-925-7371

Provider Business Practice Location Address
First Line	:	23517 MAIN ST STE 105
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-5236
Country	:	US
Telephone Number	:	424-450-0950
Fax Number	:	562-925-7371

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. MAFUTAGA S. TAGALOA-TULIFAU
Credential	:	D.P.M.
Telephone Number	:	562-925-3055

Provider Enumeration Date	:	09/25/2024
Last Update Date	:	09/25/2024

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