Provider Demographics
NPI:1225208630
Name:DR. MAFUTAGA S. TAGALOA-TULIFAU
Entity Type:Organization
Organization Name:DR. MAFUTAGA S. TAGALOA-TULIFAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:
Authorized Official - Phone:562-925-3055
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:SUITE315
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:
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:SUITE315
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41930Medicaid
CA000E41930Medicaid