Individual
MIA KATHLEEN MAURICIO TABAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
655 PARK CENTER DR, SANTEE, CA 92071-6957
(619) 596-5500
(619) 596-5501
Mailing address
655 PARK CENTER DR, SANTEE, CA 92071-6957
(619) 596-5500
(619) 596-5501
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
95226737
CA
163WG0600X
Gerontology Registered Nurse
95226737
CA
Other
Enumeration date
04/16/2021
Last updated
05/06/2021
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