Provider Demographics
NPI:1871227553
Name:TAPIA, KEVIN LEO
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEO
Last Name:TAPIA
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 1:7182 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-1210
Mailing Address - Country:US
Mailing Address - Phone:909-631-1689
Mailing Address - Fax:
Practice Address - Street 1:7182 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-1210
Practice Address - Country:US
Practice Address - Phone:909-631-1689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATYW852061708OtherBLUECROSS BLUESHIELD