Provider Demographics
NPI:1639656028
Name:TACTAY, ISMAEL D JR (RRT)
Entity Type:Individual
Prefix:MR
First Name:ISMAEL
Middle Name:D
Last Name:TACTAY
Suffix:JR
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 ZION AVENUE
Mailing Address - Street 2:RESPIRATORY CARE 4TH FLOOR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-528-7471
Mailing Address - Fax:619-528-3201
Practice Address - Street 1:4647 ZION AVENUE
Practice Address - Street 2:RESPIRATORY CARE 4TH FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:619-528-7471
Practice Address - Fax:619-528-3201
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22441227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered