Provider Demographics
NPI:1043392186
Name:FATIMA, JABEEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:JABEEN
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1801
Mailing Address - Country:US
Mailing Address - Phone:818-528-1080
Mailing Address - Fax:818-528-1255
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:SUITE 415
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1801
Practice Address - Country:US
Practice Address - Phone:818-528-1080
Practice Address - Fax:818-528-1255
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12685R207Q00000X
CAC53794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACZ709ZMedicare PIN
CAG88577Medicare UPIN