Provider Demographics
NPI:1710858527
Name:TAFOLLA, ELIAS
Entity type:Individual
Prefix:
First Name:ELIAS
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 1:100 OLD RIVER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8334
Mailing Address - Country:US
Mailing Address - Phone:661-855-7455
Mailing Address - Fax:559-334-3605
Practice Address - Street 1:100 OLD RIVER RD STE 150
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8334
Practice Address - Country:US
Practice Address - Phone:661-855-7455
Practice Address - Fax:559-334-3605
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program