Provider Demographics
NPI:1376768242
Name:TABA, KATIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:KATIA
Middle Name:E
Last Name:TABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATIA
Other - Middle Name:
Other - Last Name:TABA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3467 PINE RIDGE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3832
Mailing Address - Country:US
Mailing Address - Phone:239-325-3970
Mailing Address - Fax:239-325-3971
Practice Address - Street 1:3467 PINE RIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3832
Practice Address - Country:US
Practice Address - Phone:239-325-3970
Practice Address - Fax:239-325-3971
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD201381207W00000X
FLME109922207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GB8932Medicare PIN
FLI72757Medicare UPIN