Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 18413 | CA |
NPI | 1003061177 |
---|---|
Provider Name | Mrs. Claire Marie Tabares |
First Address | West Covina, CA 91790-3940 |
Second Address | West Covina, CA 91790-3940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2008 |
Last Update Date | 13/06/2019 |