Provider Demographics
NPI:1679390066
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:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAFUTAGA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAGALOA-TULIFAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-925-3055
Mailing Address - Street 1:23517 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5236
Mailing Address - Country:US
Mailing Address - Phone:424-450-0950
Mailing Address - Fax:562-925-7371
Practice Address - Street 1:23517 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5236
Practice Address - Country:US
Practice Address - Phone:424-450-0950
Practice Address - Fax:562-925-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty