Provider Demographics
NPI:1972808319
Name:ALILIN, TAPIN KUPTARUT
Entity type:Individual
Prefix:
First Name:TAPIN
Middle Name:KUPTARUT
Last Name:ALILIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 TRIDENT CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7741
Mailing Address - Country:US
Mailing Address - Phone:707-342-8780
Mailing Address - Fax:
Practice Address - Street 1:120 TRIDENT CT
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7741
Practice Address - Country:US
Practice Address - Phone:707-342-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-16
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07BUS00008173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist