Provider Demographics
NPI:1780846089
Name:TABERNERO, EUGENIA SAN LUIS (RN)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:SAN LUIS
Last Name:TABERNERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:TABERNERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1 EAGLE RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5100
Mailing Address - Country:US
Mailing Address - Phone:510-437-3582
Mailing Address - Fax:510-437-3611
Practice Address - Street 1:1 EAGLE RD BLDG 1
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5100
Practice Address - Country:US
Practice Address - Phone:510-437-3582
Practice Address - Fax:510-437-3611
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344918163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse