Tracy Laveria Wilborn, CERTIFICATE

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

1874 So. Business Center Drive
Same As Business Mailing Address
San Bernadino, CA 92408

Phone

(909) 386-0523

Fax

(909) 386-0529

NPI assigned

Feb 9, 2012

Last updated

Oct 14, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1023381886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1874 BUSINESS CENTER DR",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083457",
            "telephone_number": "909-386-0523",
            "fax_number": "909-386-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1874 SO. BUSINESS CENTER DRIVE",
            "address_2": "SAME AS BUSINESS MAILING ADDRESS",
            "city": "SAN BERNADINO",
            "state": "CA",
            "postal_code": "92408",
            "telephone_number": "909-386-0523",
            "fax_number": "909-386-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBORN",
        "first_name": "TRACY",
        "middle_name": "LAVERIA",
        "name_prefix": "Miss",
        "credential": "CERTIFICATE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-09",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eugene Phillip Stecz, MD
• Paul Anthony Tenette, RPN
• Lesly G Thomas, DDS
• Richard Steven Tindall, MD
• Veterans Alcohol Rehabilitation Program, Inc.- Varp, Inc.
• Soon Jo Yoon

• Community Health Worker in San Bernadino, CA
• Providers in San Bernadino, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.