Provider Demographics
NPI:1306207717
Name:TAPIA, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:TAPIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:PENNGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:94951-0833
Mailing Address - Country:US
Mailing Address - Phone:415-722-8876
Mailing Address - Fax:707-528-3007
Practice Address - Street 1:3295 MOORLAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-7841
Practice Address - Country:US
Practice Address - Phone:415-722-8876
Practice Address - Fax:707-528-3007
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE041865146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic