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General NPI Number Information
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NPI Number | 1598142168
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Entity Type | Organization
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Legal Business Name | PHABULOUS CARE, INC
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Dates
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Enumeration Date | 05/02/2015
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Last Update Date | 05/02/2015
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Provider Practice Location Address
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Address Line | 1719 LAS PALMITAS ST
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3530
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Country | US
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Telephone | 323-283-9877
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Fax |
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Provider Business Mailing Address
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Address Line | 1719 LAS PALMITAS ST
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3530
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHABILLIA AFFLACK
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Credential | M.D
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Telephone | 347-585-4987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C55443
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License Number State | CA
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