Healthcare Provider Details

I. General information

NPI: 1992582985
Provider Name (Legal Business Name): CALEB FABIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17796 SW 2ND ST
PEMBROKE PINES FL
33029-3923
US

IV. Provider business mailing address

1900 SW 8TH ST UNIT TH4
MIAMI FL
33135-3578
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-7800
  • Fax:
Mailing address:
  • Phone: 480-489-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: