Provider Demographics
NPI:1376032946
Name:SABORI, TASHINA
Entity Type:Individual
Prefix:
First Name:TASHINA
Middle Name:
Last Name:SABORI
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 1:20309 PANOCHE RD
Mailing Address - Street 2:
Mailing Address - City:PAICINES
Mailing Address - State:CA
Mailing Address - Zip Code:95043-9760
Mailing Address - Country:US
Mailing Address - Phone:408-903-9677
Mailing Address - Fax:
Practice Address - Street 1:331 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3070
Practice Address - Country:US
Practice Address - Phone:408-903-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician