Provider Demographics
NPI:1235549148
Name:TAPARRA, KIANE
Entity Type:Individual
Prefix:
First Name:KIANE
Middle Name:
Last Name:TAPARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 PALMER WAY STE A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7253
Mailing Address - Country:US
Mailing Address - Phone:619-440-5752
Mailing Address - Fax:619-440-6861
Practice Address - Street 1:1663 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3520
Practice Address - Country:US
Practice Address - Phone:619-440-5752
Practice Address - Fax:619-440-6861
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB214368Medicare PIN