Provider Demographics
NPI:1104371806
Name:PASILABAN, KLAR FULGENTES (FNP)
Entity Type:Individual
Prefix:MR
First Name:KLAR
Middle Name:FULGENTES
Last Name:PASILABAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 SPRINGGATE LN APT G
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2982
Mailing Address - Country:US
Mailing Address - Phone:805-256-7828
Mailing Address - Fax:
Practice Address - Street 1:1822 SPRINGGATE LN APT G
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2982
Practice Address - Country:US
Practice Address - Phone:805-256-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004610363LF0000X, 363LP2300X
NV813583363LP2300X
NM54130363LP2300X
WAAP61019951363LP2300X
OR202005274NP-PP363LP2300X
AZ219427363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily