Healthcare Provider Details

I. General information

NPI: 1225615818
Provider Name (Legal Business Name): ZILDJIAN TABBOGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N MORRISON AVE
SAN JOSE CA
95126-2741
US

IV. Provider business mailing address

1715 QUEENS CROSSING DR
SAN JOSE CA
95132-1762
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax: 408-462-6052
Mailing address:
  • Phone: 408-477-6809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: