Provider Demographics
NPI:1053150003
Name:TACASTACAS, HANNAH DAWN BUGAYONG
Entity type:Individual
Prefix:
First Name:HANNAH DAWN
Middle Name:BUGAYONG
Last Name:TACASTACAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH DAWN
Other - Middle Name:OZOA
Other - Last Name:BUGAYONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 ROWLAND ST APT 34
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3530
Mailing Address - Country:US
Mailing Address - Phone:845-553-0390
Mailing Address - Fax:
Practice Address - Street 1:1405 ROWLAND ST APT 34
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3530
Practice Address - Country:US
Practice Address - Phone:845-553-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1611119221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist