Provider Demographics
NPI:1093819187
Name:CENTRAL ALABAMA VETERANS HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:CENTRAL ALABAMA VETERANS HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PSYCHIATRIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA ROSARIO
Authorized Official - Middle Name:TANATE
Authorized Official - Last Name:TABINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-272-4670
Mailing Address - Street 1:215 PERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-3725
Mailing Address - Country:US
Mailing Address - Phone:334-272-4670
Mailing Address - Fax:
Practice Address - Street 1:215 PERRY HILL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3725
Practice Address - Country:US
Practice Address - Phone:334-272-4670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046297283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital