Provider Demographics
NPI:1114232980
Name:TACANDONG, LUDIVINA CALAZAN
Entity Type:Individual
Prefix:
First Name:LUDIVINA
Middle Name:CALAZAN
Last Name:TACANDONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 TOUISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-5425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2215 HOLLAND AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NEW YORK
Practice Address - Zip Code:10467
Practice Address - Country:UM
Practice Address - Phone:718-655-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY445108-1163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation