MEDICARE: ANTONIO TERRAZAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1265383996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO TERRAZAS

Provider Business Mailing Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	253-968-0117
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	253-968-0117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ ANTONIO TERRAZAS ” Practice Location

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