Provider Demographics
NPI:1790208643
Name:TAGUTA, CLIFFORD
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:TAGUTA
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 1:409 N LOOP 336 W STE 2
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1238
Mailing Address - Country:US
Mailing Address - Phone:936-224-9802
Mailing Address - Fax:
Practice Address - Street 1:409 N LOOP 336 W STE 2
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1238
Practice Address - Country:US
Practice Address - Phone:936-224-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA