Healthcare Provider Details

I. General information

NPI: 1194858274
Provider Name (Legal Business Name): YVETTE RENEE FIBEL M.A.C.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 IRVINE CENTER DR STE 107
IRVINE CA
92604-3334
US

IV. Provider business mailing address

4902 IRVINE CENTER DR STE 107
IRVINE CA
92604-3334
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-4603
  • Fax: 949-552-7184
Mailing address:
  • Phone: 949-552-4603
  • Fax: 949-552-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP7068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: