Provider Demographics
NPI:1841705399
Name:TAPIA, DAVID FONSECA (ATC, EMT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:FONSECA
Last Name:TAPIA
Suffix:
Gender:M
Credentials:ATC, EMT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1201 GLEN COVE PKWY APT 1509
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7177
Mailing Address - Country:US
Mailing Address - Phone:661-917-4299
Mailing Address - Fax:
Practice Address - Street 1:1350 S ELISEO DR
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2011
Practice Address - Country:US
Practice Address - Phone:415-798-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
E2031440146N00000X
1710I1002X
20000365852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman