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General NPI Number Information
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NPI Number | 1104371806
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Entity Type | Individual
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Provider Name | KLAR FULGENTES PASILABAN FNP
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Gender | Male
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 1822 SPRINGGATE LN APT G
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City | SIMI VALLEY
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State | CA
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Zip | 93065-2982
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Country | US
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Telephone | 805-256-7828
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 SPRINGGATE LN APT G
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City | SIMI VALLEY
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State | CA
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Zip | 93065-2982
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Country | US
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Telephone | 805-256-7828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95004610
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 813583
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 54130
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95004610
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP61019951
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License Number State | WA
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Taxonomy #6
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 202005274NP-PP
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License Number State | OR
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Taxonomy #7
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 219427
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License Number State | AZ
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