Healthcare Provider Details

I. General information

NPI: 1598542003
Provider Name (Legal Business Name): ALICIA TABOADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY STE 300
VAN NUYS CA
91405-2272
US

IV. Provider business mailing address

PO BOX 5394
PINE MOUNTAIN CLUB CA
93222-5394
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-7097
  • Fax:
Mailing address:
  • Phone: 661-699-7933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: