Individual provider Active NPI

Rita Karen Tafoya, PA

  • Physician Assistant
  • South Gate, CA
National Provider Identifier
1467567370
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA11452 Issued in CA
Practice address
9401 Long Beach Blvd
South Gate, CA 90280-4144
Phone
(323) 582-8612
Fax
(323) 567-9784
NPI assigned
Aug 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA11452 CA Primary

Addresses

Primary practice location

9401 Long Beach Blvd
South Gate, CA 90280-4144

Mailing address

PO Box 717
South Gate, CA 90280-0717
Phone (323) 582-8612

Other identifiers 2

IdentifierTypeStateIssuer
PA11452OtherCAPA LICENSE
N0515147OtherCADRIVERS LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA11452CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
M.a. Medical Group, Inc Past Accepting new patients
Maria Auxiliadora Medical Group Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467567370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 717",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902800717",
            "telephone_number": "323-582-8612",
            "fax_number": "323-567-9784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 LONG BEACH BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902804144",
            "telephone_number": "323-582-8612",
            "fax_number": "323-567-9784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAFOYA",
        "first_name": "RITA",
        "middle_name": "KAREN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA11452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA11452",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "N0515147",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Gate, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.