Provider Demographics
NPI:1740429612
Name:TAGORDA, TERENCE JAMES (SRNA)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:JAMES
Last Name:TAGORDA
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 ACKERMAN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3505
Mailing Address - Country:US
Mailing Address - Phone:323-256-4879
Mailing Address - Fax:
Practice Address - Street 1:3751 ACKERMAN DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3505
Practice Address - Country:US
Practice Address - Phone:323-256-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3819367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered