Provider Demographics
NPI:1609287044
Name:JABOURIAN, NINA
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:JABOURIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 N PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1801
Mailing Address - Country:US
Mailing Address - Phone:909-580-1862
Mailing Address - Fax:909-580-1388
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-1862
Practice Address - Fax:909-580-1388
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA14314207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine