Healthcare Provider Details

I. General information

NPI: 1871894725
Provider Name (Legal Business Name): AMIEE REBECCA TABATZKY LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 EL CAMINO REAL STE F
CARLSBAD CA
92008-7125
US

IV. Provider business mailing address

4838 MANSFIELD ST
SAN DIEGO CA
92116-1978
US

V. Phone/Fax

Practice location:
  • Phone: 760-602-0262
  • Fax: 619-269-3815
Mailing address:
  • Phone: 619-993-0663
  • Fax: 619-269-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberAC12907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: