Provider Demographics
NPI:1275082034
Name:FABE, JAMES ANGELO
Entity Type:Individual
Prefix:
First Name:JAMES ANGELO
Middle Name:
Last Name:FABE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 S WHITE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148
Mailing Address - Country:US
Mailing Address - Phone:408-274-0888
Mailing Address - Fax:408-274-2858
Practice Address - Street 1:2680 S WHITE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148
Practice Address - Country:US
Practice Address - Phone:408-274-0888
Practice Address - Fax:408-274-2858
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist