Provider Demographics
NPI:1750915427
Name:TAGUINOD, PETER JUSTIN GARCIA (DPT)
Entity type:Individual
Prefix:DR
First Name:PETER JUSTIN
Middle Name:GARCIA
Last Name:TAGUINOD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:TAGUINOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:12412 DESTINO ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 CENTERPOINTE DR
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1028
Practice Address - Country:US
Practice Address - Phone:714-522-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2982142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic