MEDICARE: TABILA MEDICAL, PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1750240917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TABILA MEDICAL, PC

Provider Business Mailing Address
First Line	:	1339 W WILLOW ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90810-3116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1339 W WILLOW ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90810-3116
Country	:	US
Telephone Number	:	562-492-6698
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTINA TABILA-GUGLIELMI
Credential	:	MD
Telephone Number	:	310-283-9864

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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