Healthcare Provider Details

I. General information

NPI: 1306273982
Provider Name (Legal Business Name): SHAZEEN FABIUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 W CANYON AVE APT 122
SAN DIEGO CA
92123-4733
US

IV. Provider business mailing address

2705 W CANYON AVE APT 122
SAN DIEGO CA
92123-4733
US

V. Phone/Fax

Practice location:
  • Phone: 786-506-4435
  • Fax:
Mailing address:
  • Phone: 786-506-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: