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General NPI Number Information
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NPI Number | 1194798207
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Entity Type | Individual
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Provider Name | FABIOLA MEDEIROS M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 2374 E PACIFICA PL
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City | COMPTON
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State | CA
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Zip | 90220
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Country | US
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Telephone | 310-225-3221
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Fax | 310-698-7040
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Provider Business Mailing Address
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Address Line | 2374 E PACIFICA PL
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City | RANCHO DOMINGUEZ
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State | CA
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Zip | 90220-6214
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Country | US
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Telephone | 310-225-3221
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Fax | 310-698-7040
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 47986
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | C54977
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License Number State | CA
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