=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306775689
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LIAT RAQUEL TUBUL FNP, RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2026
-----------------------------------------------------
Last Update Date | 05/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20700 VENTURA BLVD STE 100
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-6268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-613-7510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29028 OLD CARRIAGE CT
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-1622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-489-1936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 95033478
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------