Healthcare Provider Details

I. General information

NPI: 1992931075
Provider Name (Legal Business Name): FABIOLA OBANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W 57TH ST FL 6
NEW YORK NY
10019-2929
US

IV. Provider business mailing address

521 W 57TH ST FL 6
NEW YORK NY
10019-2929
US

V. Phone/Fax

Practice location:
  • Phone: 212-485-0765
  • Fax: 212-698-0305
Mailing address:
  • Phone: 212-485-0765
  • Fax: 212-698-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number002065
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: