Provider Demographics
NPI:1205082294
Name:TAGUIRAN, FRED
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:TAGUIRAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 ARNOLD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4189
Mailing Address - Country:US
Mailing Address - Phone:925-348-1612
Mailing Address - Fax:
Practice Address - Street 1:1340 ARNOLD DR STE 110
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4189
Practice Address - Country:US
Practice Address - Phone:925-348-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X, 175T00000X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist