Provider Demographics
NPI:1073210951
Name:TAHAR, BOBBIE LEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:LEE
Last Name:TAHAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 W AVENUE L4
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4441
Mailing Address - Country:US
Mailing Address - Phone:661-361-4999
Mailing Address - Fax:
Practice Address - Street 1:520 W PALMDALE BLVD STE Q
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4231
Practice Address - Country:US
Practice Address - Phone:661-947-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily