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General NPI Number Information
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NPI Number | 1730545005
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Entity Type | Individual
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Provider Name | ROSE ANNE FABILLAR
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Gender | Female
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Dates
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Enumeration Date | 01/02/2016
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 105 DANROSE DR
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City | VALLEJO
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State | CA
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Zip | 94589-1695
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Country | US
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Telephone | 707-319-4619
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Fax |
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Provider Business Mailing Address
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Address Line | 101 VILLAGE CT
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City | VACAVILLE
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State | CA
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Zip | 95687-6916
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Country | US
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Telephone | 707-319-4619
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | E2704785
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-19-35484
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-722
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License Number State | HI
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