Healthcare Provider Details

I. General information

NPI: 1356092795
Provider Name (Legal Business Name): MARLA FABIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SANTA MONICA BLVD STE 230
SANTA MONICA CA
90401-2625
US

IV. Provider business mailing address

701 SANTA MONICA BLVD STE 230
SANTA MONICA CA
90401-2625
US

V. Phone/Fax

Practice location:
  • Phone: 310-993-4103
  • Fax: 805-494-8385
Mailing address:
  • Phone: 310-993-4103
  • Fax: 805-494-8385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95107060
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95032340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: