Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT27382 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT27382 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT27382 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT27382 | CA |
NPI | 1104916287 |
---|---|
Provider Name | Steven Mark Tashjian |
First Address | San Diego, CA 92110-5504 |
Second Address | San Diego, CA 92123-1830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT0273820 | (05) | CA |