Provider Demographics
NPI:1306032792
Name:TABILA, BRIAN T (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:TABILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 EUCLID AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2931
Mailing Address - Country:US
Mailing Address - Phone:619-470-6195
Mailing Address - Fax:
Practice Address - Street 1:502 EUCLID AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2931
Practice Address - Country:US
Practice Address - Phone:619-470-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96984207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease