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General NPI Number Information
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NPI Number | 1760046924
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Entity Type | Individual
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Provider Name | VANESSA EDRALIN TABUNGAR NP
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Gender | Female
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 43944 15TH ST W STE 201
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City | LANCASTER
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State | CA
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Zip | 93534-5207
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Country | US
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Telephone | 661-529-7550
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Fax | 661-529-7560
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Provider Business Mailing Address
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Address Line | 10301 ALPINE DR APT 5
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City | CUPERTINO
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State | CA
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Zip | 95014-0926
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95011053
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95011053
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License Number State | CA
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