Healthcare Provider Details

I. General information

NPI: 1265107718
Provider Name (Legal Business Name): JULIAN RAY QUIRINO TAYAG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 2022 BOX KUNSAN
APO AP
96264-2022
US

IV. Provider business mailing address

UNIT 2022 BOX KUNSAN
APO AP
96264-2022
US

V. Phone/Fax

Practice location:
  • Phone: 375-782-4786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16723
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: