Healthcare Provider Details

I. General information

NPI: 1275292575
Provider Name (Legal Business Name): KRISTIAN EVA CABACUNGAN TUBERA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W SAN BERNARDINO RD
COVINA CA
91723-1515
US

IV. Provider business mailing address

210 W SAN BERNARDINO RD
COVINA CA
91723-1515
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-7331
  • Fax: 626-859-5848
Mailing address:
  • Phone: 626-938-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN95255816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: