Provider Demographics
NPI:1861610461
Name:TAFF, DAVID ALAN (MS, CMT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:TAFF
Suffix:
Gender:M
Credentials:MS, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17547
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92177-7547
Mailing Address - Country:US
Mailing Address - Phone:619-606-5668
Mailing Address - Fax:
Practice Address - Street 1:7300 GIRARD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5138
Practice Address - Country:US
Practice Address - Phone:619-606-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18121172M00000X
NC982225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist