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NPI Code Detail

MEDICARE: TABETHA JAMES RBT

MEDICARE: TABETHA JAMES RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-18-55593CA

General Provider Information

NPI Number : 1720578628
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABETHA JAMES RBT
Provider Business Mailing Address
First Line : 6475 SIERRA LN
Second Line :
City : DUBLIN
State : CA
Zip : 94568-2796
Country : US
Telephone Number : 925-462-2281
Fax Number :
Provider Business Practice Location Address
First Line : 1577 GUERNEVILLE RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-4108
Country : US
Telephone Number : 707-527-0332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2018
Last Update Date : 05/16/2018

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