Provider Demographics
NPI:1881805851
Name:TAPIA, BORIS DEMITRY (PA-C)
Entity type:Individual
Prefix:MR
First Name:BORIS
Middle Name:DEMITRY
Last Name:TAPIA
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:28119 OAKLAR DR
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1843
Mailing Address - Country:US
Mailing Address - Phone:661-296-6088
Mailing Address - Fax:951-486-4106
Practice Address - Street 1:26520 CACTUS AVE
Practice Address - Street 2:DEPT. OF ORTHOPAEDIC SURGERY
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-5690
Practice Address - Fax:951-486-4106
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2021-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA18532363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical