Provider Demographics
NPI:1417543513
Name:FARABEE, AUBREY LYNN
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:LYNN
Last Name:FARABEE
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 1:1150 S OLIVE ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2871
Mailing Address - Country:US
Mailing Address - Phone:213-821-5977
Mailing Address - Fax:
Practice Address - Street 1:1150 S OLIVE ST STE 1400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2871
Practice Address - Country:US
Practice Address - Phone:213-821-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program