Provider Demographics
NPI:1376987941
Name:TAGUIBAO, ROBERTO ALVARO ALLAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO ALVARO
Middle Name:ALLAM
Last Name:TAGUIBAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:305 PARK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4426
Mailing Address - Country:US
Mailing Address - Phone:559-326-2800
Mailing Address - Fax:559-326-2801
Practice Address - Street 1:305 PARK CREEK DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611
Practice Address - Country:US
Practice Address - Phone:559-326-2800
Practice Address - Fax:559-326-2801
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138374207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program