Individual
MRS. DERANEE PEARL G TABOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
541 S HAM LN STE A&B, LODI, CA 95242-3059
(209) 224-8940
Mailing address
541 S HAM LN STE A&B, LODI, CA 95242-3059
(209) 224-8940
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
704752
CA
Other
Enumeration date
11/10/2025
Last updated
12/03/2025
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