Healthcare Provider Details

I. General information

NPI: 1104916287
Provider Name (Legal Business Name): STEVEN MARK TASHJIAN MPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 RUFFIN RD STE F
SAN DIEGO CA
92123-1830
US

IV. Provider business mailing address

4371 LOMA RIVIERA CT
SAN DIEGO CA
92110-5504
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-5570
  • Fax: 858-279-5303
Mailing address:
  • Phone: 619-301-0560
  • Fax: 858-279-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT27382
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT27382
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT27382
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT27382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: