Provider Demographics
NPI:1225313539
Name:FABILLARAN, GLORIA BERNADETH
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:BERNADETH
Last Name:FABILLARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-2600
Mailing Address - Country:US
Mailing Address - Phone:805-604-7531
Mailing Address - Fax:
Practice Address - Street 1:1801 N ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-2600
Practice Address - Country:US
Practice Address - Phone:805-604-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH56139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist