Basic Information
Provider Information
NPI: 1508259771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TABING
FirstName: ARIANA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 38400 BOB WILSON DR
Address2: NAVAL MEDICAL CTR
City: SAN DIEGO
State: CA
PostalCode: 921343300
CountryCode: US
TelephoneNumber: 6195329795
FaxNumber:  
Practice Location
Address1: NAVAL MEDICAL CTR
Address2: 34800 BOB WILSON DRIVE
City: SAN DIEGO
State: CA
PostalCode: 921345000
CountryCode: US
TelephoneNumber: 6195329795
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/12/2015
LastUpdateDate: 03/19/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171000000X  Y Other Service ProvidersMilitary Health Care Provider 

No ID Information.


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