Provider Demographics
NPI:1891337671
Name:FRABONI, DOMENIC FOBBE (DPT)
Entity Type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:FOBBE
Last Name:FRABONI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13273 FIJI WAY APT 433
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7096
Mailing Address - Country:US
Mailing Address - Phone:763-772-5299
Mailing Address - Fax:
Practice Address - Street 1:3916 SEPULVEDA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4651
Practice Address - Country:US
Practice Address - Phone:866-960-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-12
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11258225100000X
CA297455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist