Provider Demographics
NPI:1750847133
Name:TABERNER, HANA LEE
Entity type:Individual
Prefix:
First Name:HANA
Middle Name:LEE
Last Name:TABERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 FENTON PKWY # 107-262
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4746
Mailing Address - Country:US
Mailing Address - Phone:858-876-4159
Mailing Address - Fax:
Practice Address - Street 1:2307 FENTON PKWY # 107-262
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4746
Practice Address - Country:US
Practice Address - Phone:858-876-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist