Provider Demographics
NPI:1376292706
Name:TABOADA, CHRISTINA MELISSA (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MELISSA
Last Name:TABOADA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42415 RANCHO LAS PALMAS DR APT 15
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4335
Mailing Address - Country:US
Mailing Address - Phone:760-485-6803
Mailing Address - Fax:
Practice Address - Street 1:42415 RANCHO LAS PALMAS DR APT 15
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4335
Practice Address - Country:US
Practice Address - Phone:760-485-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95218603163WM0705X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical