Provider Demographics
NPI:1548823313
Name:TAFOLLA, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:TAFOLLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4329 MAJESTY CT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-2507
Mailing Address - Country:US
Mailing Address - Phone:815-721-3797
Mailing Address - Fax:
Practice Address - Street 1:4329 MAJESTY CT
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-2507
Practice Address - Country:US
Practice Address - Phone:815-721-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle