Provider Demographics
NPI:1275070617
Name:BERLANGA, FABRICIO (LAT LICENSE-AT5556)
Entity Type:Individual
Prefix:MR
First Name:FABRICIO
Middle Name:
Last Name:BERLANGA
Suffix:
Gender:M
Credentials:LAT LICENSE-AT5556
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-3022
Mailing Address - Country:US
Mailing Address - Phone:254-716-7414
Mailing Address - Fax:
Practice Address - Street 1:1100 COLLEGE CIR
Practice Address - Street 2:
Practice Address - City:RANGER
Practice Address - State:TX
Practice Address - Zip Code:76470-3203
Practice Address - Country:US
Practice Address - Phone:254-716-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT55562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty