Provider Demographics
NPI:1467567370
Name:TAFOYA, RITA KAREN (PA)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:KAREN
Last Name:TAFOYA
Suffix:
Gender:F
Credentials:PA
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 717
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-0717
Mailing Address - Country:US
Mailing Address - Phone:323-582-8612
Mailing Address - Fax:323-567-9784
Practice Address - Street 1:9401 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-4144
Practice Address - Country:US
Practice Address - Phone:323-582-8612
Practice Address - Fax:323-567-9784
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11452363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA11452OtherPA LICENSE
CAN0515147OtherDRIVERS LICENSE