Individual
MRS. BLANCA ISELA TABARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5671 SANTA TERESA BLVD, SUITE105, SAN JOSE, CA 95123-6512
(408) 284-2280
(408) 754-0450
Mailing address
5671 SANTA TERESA BLVD, SUITE105, SAN JOSE, CA 95123-6512
(408) 284-2280
(408) 754-0450
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
27775
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ00543Z
MEDICARE
CA
Enumeration date
06/10/2008
Last updated
01/22/2014
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