Healthcare Provider Details

I. General information

NPI: 1033201405
Provider Name (Legal Business Name): FATIMA CABAL TAGLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATIMA CASTANAR CABAL

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 E GREENWAY RD
PHOENIX AZ
85032-4548
US

IV. Provider business mailing address

21618 N 44TH PL
PHOENIX AZ
85050-6934
US

V. Phone/Fax

Practice location:
  • Phone: 602-325-5577
  • Fax: 415-252-7176
Mailing address:
  • Phone: 480-513-0793
  • Fax: 480-513-0793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704203126
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberC-APN.0002138-C-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP3316
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: