Provider Demographics
NPI:1598206112
Name:TAPATI, TCHILALO MEHEZA
Entity Type:Individual
Prefix:
First Name:TCHILALO
Middle Name:MEHEZA
Last Name:TAPATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TCHILALO
Other - Middle Name:MEHEZA
Other - Last Name:TAPATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7600 GEORGIA AVE, #323
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012
Mailing Address - Country:US
Mailing Address - Phone:202-723-3060
Mailing Address - Fax:202-723-3065
Practice Address - Street 1:7600 GEORGIA AVE, #323
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-723-3060
Practice Address - Fax:202-723-3065
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12517172V00000X
DCHHA 12517374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker