Provider Demographics
NPI:1891666335
Name:TACAZON, ANDREW FLORENTINO JR (PTA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:FLORENTINO
Last Name:TACAZON
Suffix:JR
Gender:M
Credentials:PTA
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Other - First Name:
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Mailing Address - Street 1:8692 9TH ST UNIT 44
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8692 9TH ST UNIT 44
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0818
Practice Address - Country:US
Practice Address - Phone:909-789-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA54330225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant