Provider Demographics
NPI:1114973468
Name:FABELLA, EMMANUEL TORREFIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:TORREFIEL
Last Name:FABELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2053
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93275-2053
Mailing Address - Country:US
Mailing Address - Phone:559-687-8200
Mailing Address - Fax:559-687-8282
Practice Address - Street 1:880 E MERRITT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2244
Practice Address - Country:US
Practice Address - Phone:559-687-8200
Practice Address - Fax:559-687-8282
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C519560Medicaid
G02553Medicare UPIN
00C519561Medicare PIN