Provider Demographics
NPI:1376217232
Name:TABORA, KNAYA CORAZON I (RN)
Entity Type:Individual
Prefix:MS
First Name:KNAYA
Middle Name:CORAZON
Last Name:TABORA
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 BAILEY AVE
Mailing Address - Street 2:MODULAR OFFICE BUILDING
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-3104
Mailing Address - Country:US
Mailing Address - Phone:760-326-7100
Mailing Address - Fax:760-459-2210
Practice Address - Street 1:1401 BAILEY AVE
Practice Address - Street 2:MODULAR OFFICE BUILDING
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3104
Practice Address - Country:US
Practice Address - Phone:760-326-7100
Practice Address - Fax:760-459-2210
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA346762163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator