Brian Eijiro Tabata, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

52659 Issued in CA

Practice address

41949 Big Bear Blvd
Big Bear Lake, CA 92315

Phone

(909) 878-3696

NPI assigned

Jul 24, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444608000000",
    "number": "1437534005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41949 BIG BEAR BLVD",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "92315",
            "telephone_number": "909-878-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41949 BIG BEAR BLVD",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "92315",
            "telephone_number": "909-878-3696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABATA",
        "first_name": "BRIAN",
        "middle_name": "EIJIRO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-24",
        "last_updated": "2015-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA PA LICENSE NUMBER",
            "identifier": "52659",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary S Stanford, P.T., O.C.S.
• Melissa Ann Staricka, N.P.
• Paul F. Stemmer, MD
• Louanne Strickland, MFT
• Shonda Lyn Szabo
• Sarah Talbot
• Charise Taylor
• Corrynne Taylor
• The Doctor'S House, Inc
• The Mom & Dad Project

• Physician Assistant in Big Bear Lake, CA
• Providers in Big Bear Lake, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2015; 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.