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Individual
MIA KATHLEEN MAURICIO TABAGO
Active
Individual
MIA KATHLEEN MAURICIO TABAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
95226737
CA
163WG0600X
Gerontology Registered Nurse
95226737
CA
363LF0000X
Family Nurse Practitioner
Primary
95040457
CA
Other
Enumeration date
04/16/2021
Last updated
07/11/2026
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