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General NPI Number Information
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NPI Number | 1326166554
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Entity Type | Individual
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Provider Name | DAVID MICHAEL FABRIZIO P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 120 N ROBERTSON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-3115
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Country | US
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Telephone | 310-854-5949
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Fax | 310-854-6049
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Provider Business Mailing Address
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Address Line | 1940 CALGARY LN
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City | LOS ANGELES
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State | CA
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Zip | 90077-2805
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Country | US
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Telephone | 310-854-5949
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Fax | 310-854-6049
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 17351
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License Number State | CA
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