Provider Demographics
NPI:1427049162
Name:TACATA, FELISA PADUA (MD)
Entity type:Individual
Prefix:DR
First Name:FELISA
Middle Name:PADUA
Last Name:TACATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2701 DEL PASO RD
Mailing Address - Street 2:# 130-239
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2305
Mailing Address - Country:US
Mailing Address - Phone:916-486-7555
Mailing Address - Fax:916-486-7557
Practice Address - Street 1:2951 FULTON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4909
Practice Address - Country:US
Practice Address - Phone:916-486-7555
Practice Address - Fax:916-486-7557
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA948192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A948190Medicare PIN