Provider Demographics
NPI:1235628165
Name:MUNETON, FABIOLA
Entity Type:Individual
Prefix:MRS
First Name:FABIOLA
Middle Name:
Last Name:MUNETON
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 1:864 N SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3123
Mailing Address - Country:US
Mailing Address - Phone:162-667-2915
Mailing Address - Fax:
Practice Address - Street 1:864 N SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-3123
Practice Address - Country:US
Practice Address - Phone:162-667-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12345OtherHEALTHNET