Tana Cabanillas
Individual provider Active NPI Physician Assistant · Carson, CA
NPI 1134907652 · NPPES record last updated Apr 29, 2024
Key facts
- NPI
- 1134907652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 64189 (CA)
- Practice address
- 19815 Annalee Ave
Carson, CA 90746-3146 - Phone
- (407) 579-2013
- NPI assigned
- Sep 18, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240511000291 | CA | Practitioner - Physician Assistant | 1456792209 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Unicare Community Health Center, Inc. | Current |
Accepting new patients | |
| Unicare Community Health Center, Inc. | Current |
Accepting new patients |
Locations
107 N McKinley St
Corona, CA 92879
Phone (951) 358-0141
1151 E Walnut St
Ontario, CA 91761
Phone (909) 467-0797
437 N Euclid Ave
Ontario, CA 91762
Phone (909) 749-1835
1501 E Holt Ave
Ste A
Pomona, CA 91767
Phone (909) 623-3600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 64189 | CA | Yes |
Addresses
Primary practice location
19815 Annalee Ave
Carson, CA 90746-3146
Mailing address
19815 Annalee Ave
Carson, CA 90746-3146
Phone (407) 579-2013
Other providers in Carson, CA
- Christopher D Bustamante
- Brandon Leuterio Butawan
- C&C Senior Care Foundation Inc.
- Daelene Zeta Villanueva Cabahug
- Janice Caballero
- Jesstofed Manuel Cacho
- Daniela Guzman Calderon
- Edward Leo Callahan
- Francisco Palma Camacho Jr.
- Samuel A Campbell
All providers in Carson, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.