Provider Demographics
NPI:1295552321
Name:DEFABIIS, VINCENT (MS, PPS)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:DEFABIIS
Suffix:
Gender:
Credentials:MS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W D ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3026
Mailing Address - Country:US
Mailing Address - Phone:909-984-3634
Mailing Address - Fax:
Practice Address - Street 1:5625 KINGSLEY ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-3999
Practice Address - Country:US
Practice Address - Phone:909-984-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
CA240042053101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No171400000XOther Service ProvidersHealth & Wellness Coach