Provider Demographics
NPI:1962435594
Name:TAGALOA-TULIFAU, MAFUTAGA S (DPM)
Entity type:Individual
Prefix:DR
First Name:MAFUTAGA
Middle Name:S
Last Name:TAGALOA-TULIFAU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2618
Mailing Address - Country:US
Mailing Address - Phone:562-925-3055
Mailing Address - Fax:562-925-7371
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2618
Practice Address - Country:US
Practice Address - Phone:562-925-3055
Practice Address - Fax:562-925-7371
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4193213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41930Medicaid
CA000E41930Medicaid
CAE4193Medicare PIN
CAE4193Medicare PIN