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1760046924 NPI number — VANESSA EDRALIN TABUNGAR NP

NPI Number: 1760046924
Health Care Provider/Practitioner: VANESSA EDRALIN TABUNGAR NP

Information about “1760046924” NPI (VANESSA EDRALIN TABUNGAR NP) exists in 1760046924 in HTML format HTML  |  1760046924 in plain Text format TXT  |  1760046924 in PDF (Portable Document Format) PDF  |  1760046924 in an XML format XML  formats.

NPI Number : 1760046924 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760046924",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TABUNGAR",
    "FirstName": "VANESSA",
    "MiddleName": "EDRALIN",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10301 ALPINE DR APT 5",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CUPERTINO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95014-0926",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "43944 15TH ST W STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LANCASTER",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93534-5207",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "661-529-7550",
    "PracticeLocationAddressFaxNumber": "661-529-7560",
    "EnumerationDate": "04/23/2019",
    "LastUpdateDate": "10/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "95011053",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "NP95011053",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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