Active NPI
Regina Tabora
- Nurse Practitioner
- San Diego, CA
National Provider Identifier
1194291351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95022591
- Practice address
- 3350 La Jolla Village Dr
San Diego, CA 92161-0002 - Phone
- (858) 552-8585
- NPI assigned
- Oct 15, 2018
- Last updated
- Nov 5, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 95150323 | CA | |
| Nurse Practitioner | 363L00000X | 95022591 | CA | Primary |
Addresses
Primary practice location
3350 La Jolla Village Dr
San Diego, CA 92161-0002
Mailing address
12425 Robison Blvd
Poway, CA 92064-4319
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95150323 | CA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Universal Care | Current | Accepting new patients | |
| Central Health Plan of California, Inc. | Current | Accepting new patients |
Locations
200 Oceangate
Ste 100
Long Beach, CA 90802
Phone (562) 435-3666
Interoperability endpoints
- rtabora15053@direct-prd.molinahealthcare.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Health Maintenance Organization
- Diamond Bar, CA
- NPI 1386714772
-
dba Molina Medical Centers
- Health Maintenance Organization
- Long Beach, CA
- NPI 1194811760
-
- Pediatrics Physician
- Long Beach, CA
- NPI 1376632877
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667606400000",
"number": "1194291351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12425 ROBISON BLVD",
"city": "POWAY",
"state": "CA",
"postal_code": "920644319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 LA JOLLA VILLAGE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921610002",
"telephone_number": "858-552-8585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TABORA",
"first_name": "REGINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-15",
"last_updated": "2022-11-05",
"certification_date": "2022-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "95150323",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95022591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.