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NPI Code Detail

MEDICARE: MR. TODD FABIAN MA, BCBA

MEDICARE: MR. TODD FABIAN MA, BCBA
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
1101Y00000XCounselor
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1619090701
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TODD FABIAN MA, BCBA
Provider Business Mailing Address
First Line : 19415 BENEDICT DR
Second Line :
City : WOODBRIDGE
State : CA
Zip : 95258-9027
Country : US
Telephone Number : 209-993-5688
Fax Number :
Provider Business Practice Location Address
First Line : 405 E PINE ST
Second Line :
City : STOCKTON
State : CA
Zip : 95204-5522
Country : US
Telephone Number : 209-464-5519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 12/27/2023

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