MEDICARE: JOHN NEIL TABIN DEANG

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	3747A0650X	Attendant Care Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y7544968	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1790642346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NEIL TABIN DEANG

Provider Business Mailing Address
First Line	:	10290 BLACK MOUNTAIN RD APT 209
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-3839
Country	:	US
Telephone Number	:	619-717-9921
Fax Number	:

Provider Business Practice Location Address
First Line	:	15152 HUNTINGTON CT
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-3069
Country	:	US
Telephone Number	:	858-254-2664
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ JOHN NEIL TABIN DEANG ” Practice Location

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