Healthcare Provider Details

I. General information

NPI: 1336171438
Provider Name (Legal Business Name): JACQUES ORSABIA TAJUNA PT, CSCS, CMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 NEW CENTER PT
COLORADO SPRINGS CO
80922-2806
US

IV. Provider business mailing address

545 W LOS ANGELES AVE
MOORPARK CA
93021-1709
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5842
  • Fax:
Mailing address:
  • Phone: 805-530-3838
  • Fax: 805-530-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28978
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL0009482
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: