Individual
PEDRO TABERNERO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
1904 RICHLAND AVE, CERES, CA 95307-4562
(209) 300-8800
Mailing address
1536 MAEHL DR, MANTECA, CA 95337-7215
(925) 216-7030
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
794686
CA
Other
Enumeration date
01/16/2016
Last updated
01/16/2016
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