Healthcare Provider Details

I. General information

NPI: 1366573669
Provider Name (Legal Business Name): MR. MARTIN SCOTT FABIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD RM 200
SALINAS CA
93906-3122
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD BUILDING 500
SALINAS CA
93906-3100
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4300
  • Fax:
Mailing address:
  • Phone: 831-755-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: