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Individual
KRISTA BASILE TABUENCA
Active
Individual
KRISTA BASILE TABUENCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY34041
CA
2084P0800X
Psychiatry Physician
PSY34041
CA
Other
Enumeration date
08/30/2018
Last updated
07/15/2024
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