Provider Demographics
NPI:1366119349
Name:TAGORDA, JASMINE (OTR)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:TAGORDA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24391 AVENIDA DE LA CARLOTA APT 370
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7655
Mailing Address - Country:US
Mailing Address - Phone:626-483-7855
Mailing Address - Fax:
Practice Address - Street 1:1640 NEWPORT BLVD STE 260
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-7736
Practice Address - Country:US
Practice Address - Phone:949-335-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist