Individual
TABITHA INDRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25671 PADUA DR, LAGUNA HILLS, CA 92653-5119
(949) 903-2700
Mailing address
25671 PADUA DR, LAGUNA HILLS, CA 92653-5119
(949) 903-2700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
790440
CA
363LP2300X
Primary Care Nurse Practitioner
Primary
95006380
CA
Other
Enumeration date
04/05/2017
Last updated
04/05/2017
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