Knaya Corazon Tabora I, RN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

346762 Issued in CA

Practice address

1401 Bailey Ave
Modular Office Building
Needles, CA 92363-3104

Phone

(760) 326-7100

Fax

(760) 459-2210

NPI assigned

Aug 4, 2021

Sex

Female

Sole proprietor

Yes

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

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1376217232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 BAILEY AVE",
            "address_2": "MODULAR OFFICE BUILDING",
            "city": "NEEDLES",
            "state": "CA",
            "postal_code": "923633104",
            "telephone_number": "760-326-7100",
            "fax_number": "760-459-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 BAILEY AVE",
            "address_2": "MODULAR OFFICE BUILDING",
            "city": "NEEDLES",
            "state": "CA",
            "postal_code": "923633104",
            "telephone_number": "760-326-7100",
            "fax_number": "760-459-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABORA",
        "first_name": "KNAYA",
        "middle_name": "CORAZON",
        "name_prefix": "Ms.",
        "name_suffix": "I",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-04",
        "last_updated": "2021-08-04",
        "certification_date": "2021-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "CA",
            "license": "346762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David C Rubio
• Carl A Russell
• Stacia Shaver
• Alia Ali Smith, LMFT
• Karl Udalve Tabora
• Thrifty Payless Inc
• Tri-State Community Healthcare Center
• Tri-State Community Healthcare Center
• Tri-State Vascular Group, PLLC
• Tristate Ambulatory Surgery Center

• All providers in Needles, CA
• Administrator Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.