Provider Demographics
NPI:1245772300
Name:TUBURAN, ISIDRA B
Entity Type:Individual
Prefix:MRS
First Name:ISIDRA
Middle Name:B
Last Name:TUBURAN
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 1:7911 41ST AVE APT C109
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1204
Mailing Address - Country:US
Mailing Address - Phone:929-261-6801
Mailing Address - Fax:
Practice Address - Street 1:7911 41ST AVE APT C109
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1204
Practice Address - Country:US
Practice Address - Phone:929-261-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY205-618-099OtherSTATE ID