Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.
MIA KATHLEEN MAURICIO TABAGO FNP
NPI 1396326856
Nurse Practitioner - Family in Alpine, CA
Active since April 16, 2021
About Mia Kathleen Mauricio Tabago Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MIA KATHLEEN MAURICIO TABAGO FNP (NPI 1396326856) is an individual family provider in Alpine, California, licensed in California (95040457) and active in the NPI registry since April 2021.
NPPES Registry Identity
NPI1396326856
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMIA KATHLEEN MAURICIO TABAGOCredential: FNP
Location Address1832 ALPINE BLVD STE BAlpine, CA 91901-2107
Mailing Address1832 Alpine Blvd Ste BAlpine, CA 91901-2107 · (619) 326-4445
Phone(619) 326-4445
Sole ProprietorYes
Enumeration DateApril 16, 2021
Last NPPES UpdateJuly 11, 20263 updates tracked since enumeration
NPPES CertifiedJuly 11, 2026
✔ NPI 1396326856 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses 2
★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in CA · 95040457
Also ListedRegistered Nurse · GerontologyTaxonomy 163WG0600X · License 95226737 (CA)
1832 ALPINE BLVD STE B, Alpine, CA 91901
Group Practice 1
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1396326856, enumerated as an "individual" on April 16, 2021.
The provider is located at 1832 ALPINE BLVD STE B ALPINE, CA 91901 and the phone number is (619) 326-4445.
Nurse Practitioner with taxonomy code 363LF0000X and a focus in Family.
