Provider Demographics
NPI:1548019979
Name:TABORA, VIRGINIA SOBEJANA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:SOBEJANA
Last Name:TABORA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N. WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2049
Mailing Address - Country:US
Mailing Address - Phone:818-585-8148
Mailing Address - Fax:
Practice Address - Street 1:618 N. WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2049
Practice Address - Country:US
Practice Address - Phone:818-585-8148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548792163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health