Healthcare Provider Details

I. General information

NPI: 1316720428
Provider Name (Legal Business Name): OSVALDO DAVID FABELO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16565 NE 4TH AVE
NORTH MIAMI BEACH FL
33162-3511
US

IV. Provider business mailing address

18856 NW 2ND ST
PEMBROKE PINES FL
33029-3279
US

V. Phone/Fax

Practice location:
  • Phone: 305-450-6641
  • Fax:
Mailing address:
  • Phone: 305-450-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11028074
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11028074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: