Healthcare Provider Details

I. General information

NPI: 1295474468
Provider Name (Legal Business Name): PHOEBE CLAIRE TABARANZA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9095 RIO SAN DIEGO DR STE 425
SAN DIEGO CA
92108-1679
US

IV. Provider business mailing address

2492 ANTLERS WAY
SAN MARCOS CA
92078-2140
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-5524
  • Fax: 858-587-9377
Mailing address:
  • Phone: 201-919-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberNP95020187
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95020187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: