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General NPI Number Information
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NPI Number | 1598352585
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Entity Type | Individual
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Provider Name | JANELLE TACLOB FABIA
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Gender | Female
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Dates
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Enumeration Date | 12/24/2020
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Last Update Date | 12/27/2020
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Provider Practice Location Address
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Address Line | 500 W 4TH ST
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City | ODESSA
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State | TX
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Zip | 79761-5001
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Country | US
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Telephone | 432-640-1725
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Fax |
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Provider Business Mailing Address
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Address Line | 2 DE VACA CT
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City | ODESSA
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State | TX
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Zip | 79765-1430
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Country | US
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Telephone | 432-770-8886
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 1022071
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License Number State | TX
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