Healthcare Provider Details

I. General information

NPI: 1316025265
Provider Name (Legal Business Name): ROWENE MAMURI FABIAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S COMMONWEALTH AVE FL 2
LOS ANGELES CA
90005-4001
US

IV. Provider business mailing address

600 SOUTH COMMONWEALTH AVE, 2ND FLR.
LOS ANGELES CA
90005
US

V. Phone/Fax

Practice location:
  • Phone: 213-739-2383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number498846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: