Provider Demographics
NPI:1245355783
Name:TAYAG, ELEAZAR SOMINTAC (PT)
Entity type:Individual
Prefix:DR
First Name:ELEAZAR
Middle Name:SOMINTAC
Last Name:TAYAG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 BIG CHIEF DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6869
Mailing Address - Country:US
Mailing Address - Phone:909-509-6064
Mailing Address - Fax:760-983-5588
Practice Address - Street 1:12381 BALI ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-6825
Practice Address - Country:US
Practice Address - Phone:909-509-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist