Healthcare Provider Details

I. General information

NPI: 1790642346
Provider Name (Legal Business Name): JOHN NEIL TABIN DEANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15152 HUNTINGTON CT
POWAY CA
92064-3069
US

IV. Provider business mailing address

10290 BLACK MOUNTAIN RD APT 209
SAN DIEGO CA
92126-3839
US

V. Phone/Fax

Practice location:
  • Phone: 858-254-2664
  • Fax:
Mailing address:
  • Phone: 619-717-9921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: