Provider Demographics
NPI:1336171438
Name:TAJUNA, JACQUES ORSABIA (PT, CSCS, CMP)
Entity Type:Individual
Prefix:MR
First Name:JACQUES
Middle Name:ORSABIA
Last Name:TAJUNA
Suffix:
Gender:M
Credentials:PT, CSCS, CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1709
Mailing Address - Country:US
Mailing Address - Phone:805-530-3838
Mailing Address - Fax:805-530-3832
Practice Address - Street 1:2999 NEW CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2806
Practice Address - Country:US
Practice Address - Phone:719-365-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28978225100000X
COPTL00094822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT28978CMedicare ID - Type Unspecified