Provider Demographics
NPI:1477181527
Name:SPRALJA, FABIJAN (NP)
Entity Type:Individual
Prefix:
First Name:FABIJAN
Middle Name:
Last Name:SPRALJA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-0606
Mailing Address - Country:US
Mailing Address - Phone:323-420-9855
Mailing Address - Fax:
Practice Address - Street 1:12000 VISTA DEL MAR
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8504
Practice Address - Country:US
Practice Address - Phone:213-833-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013026363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner