Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | MD00047630 | WA |
NPI | 1255532180 |
---|---|
Provider Name | Dr. Anthony F. Tagavilla |
First Address | Renton, WA 98055-5744 |
Second Address | Renton, WA 98055-5744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |