Provider Demographics
NPI:1972086882
Name:TAGALOA-TULIFAU FOOT AND ANKLE CENTER, INC.
Entity type:Organization
Organization Name:TAGALOA-TULIFAU FOOT AND ANKLE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAFUTAGA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGALOA-TULIFAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-925-3055
Mailing Address - Street 1:5220 CLARK AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2635
Mailing Address - Country:US
Mailing Address - Phone:562-925-3055
Mailing Address - Fax:562-925-7371
Practice Address - Street 1:5220 CLARK AVE STE 315
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2635
Practice Address - Country:US
Practice Address - Phone:562-925-3055
Practice Address - Fax:562-925-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4193213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty