Provider Demographics
NPI:1295474468
Name:TABARANZA, PHOEBE CLAIRE (NP-C)
Entity type:Individual
Prefix:MISS
First Name:PHOEBE
Middle Name:CLAIRE
Last Name:TABARANZA
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2492 ANTLERS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2140
Mailing Address - Country:US
Mailing Address - Phone:201-919-1683
Mailing Address - Fax:
Practice Address - Street 1:9095 RIO SAN DIEGO DR STE 425
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1679
Practice Address - Country:US
Practice Address - Phone:858-455-5524
Practice Address - Fax:858-587-9377
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP95020187207VX0201X
CA95020187363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology