MEDICARE: LIAT RAQUEL TUBUL FNP, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95033478	CA

General Provider Information

NPI Number	:	1306775689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIAT RAQUEL TUBUL FNP, RN

Provider Business Mailing Address
First Line	:	29028 OLD CARRIAGE CT
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1622
Country	:	US
Telephone Number	:	818-489-1936
Fax Number	:

Provider Business Practice Location Address
First Line	:	20700 VENTURA BLVD STE 100
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-6268
Country	:	US
Telephone Number	:	818-613-7510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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