MEDICARE: MR. JACQUES ORSABIA TAJUNA PT, CSCS, CMP

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	225100000X	Physical Therapist	PT28978	CA
2	2251X0800X	Orthopedic Physical Therapist	PTL0009482	CO

General Provider Information

NPI Number	:	1336171438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACQUES ORSABIA TAJUNA PT, CSCS, CMP

Provider Business Mailing Address
First Line	:	545 W LOS ANGELES AVE
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-1709
Country	:	US
Telephone Number	:	805-530-3838
Fax Number	:	805-530-3832

Provider Business Practice Location Address
First Line	:	2999 NEW CENTER PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2806
Country	:	US
Telephone Number	:	719-365-5842
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/07/2020

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