Provider Demographics
NPI:1780629667
Name:GATMAITAN-FABELLA, NECETAS INEZ TENGCO (MD)
Entity Type:Individual
Prefix:DR
First Name:NECETAS INEZ
Middle Name:TENGCO
Last Name:GATMAITAN-FABELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:INEZ
Other - Middle Name:G
Other - Last Name:FABELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:880 E MERRITT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2244
Mailing Address - Country:US
Mailing Address - Phone:559-687-8200
Mailing Address - Fax:559-687-8282
Practice Address - Street 1:880 E MERRITT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2244
Practice Address - Country:US
Practice Address - Phone:559-687-8200
Practice Address - Fax:559-687-8282
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C520190Medicaid
CA00C520190Medicaid
00C520190Medicare PIN