Individual
DAVID FONSECA TAPIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, EMT
Contact information
Practice address
1350 S ELISEO DR, GREENBRAE, CA 94904-2011
(415) 798-0651
Mailing address
1201 GLEN COVE PKWY APT 1509, VALLEJO, CA 94591-7177
(661) 917-4299
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
E2031440
—
1710I1002X
Independent Duty Corpsman
—
—
2255A2300X
Athletic Trainer
Primary
2000036585
—
Other
Enumeration date
12/06/2017
Last updated
06/30/2020
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