Provider Demographics
NPI:1467030817
Name:TAUTOLO, HOREPA MONIQUE
Entity Type:Individual
Prefix:
First Name:HOREPA
Middle Name:MONIQUE
Last Name:TAUTOLO
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 1:1282 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4801
Mailing Address - Country:US
Mailing Address - Phone:415-579-3021
Mailing Address - Fax:415-941-7313
Practice Address - Street 1:1282 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4801
Practice Address - Country:US
Practice Address - Phone:415-579-3021
Practice Address - Fax:415-941-7313
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty