MEDICARE: MRS. YVETTE RENEE FIBEL M.A.C.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP7068	CA

General Provider Information

NPI Number	:	1194858274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVETTE RENEE FIBEL M.A.C.C.C.

Provider Business Mailing Address
First Line	:	4902 IRVINE CENTER DR STE 107
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-3334
Country	:	US
Telephone Number	:	949-552-4603
Fax Number	:	949-552-7184

Provider Business Practice Location Address
First Line	:	4902 IRVINE CENTER DR STE 107
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-3334
Country	:	US
Telephone Number	:	949-552-4603
Fax Number	:	949-552-7184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	05/19/2008

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