Healthcare Provider Details

I. General information

NPI: 1477100568
Provider Name (Legal Business Name): NORA FABRIGAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2414
US

IV. Provider business mailing address

1720 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2414
US

V. Phone/Fax

Practice location:
  • Phone: 323-265-5037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number655395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: