Provider Demographics
NPI:1134850498
Name:FABIAN-NAVARRETE, TANIA
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:FABIAN-NAVARRETE
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 1:517 N 12TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4545
Mailing Address - Country:US
Mailing Address - Phone:956-460-8613
Mailing Address - Fax:
Practice Address - Street 1:906 S BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7129
Practice Address - Country:US
Practice Address - Phone:956-447-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant