Healthcare Provider Details

I. General information

NPI: 1427537422
Provider Name (Legal Business Name): RONALD WILLIAM TANDAZO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 GARFIELD AVE APT G
SOUTH PASADENA CA
91030-2223
US

IV. Provider business mailing address

304 GARFIELD AVE APT G
SOUTH PASADENA CA
91030-2223
US

V. Phone/Fax

Practice location:
  • Phone: 646-577-7091
  • Fax:
Mailing address:
  • Phone: 646-577-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number049433
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: