Provider Demographics
NPI:1932255270
Name:INEZ G. FABELLA, M.D., INC.
Entity Type:Organization
Organization Name:INEZ G. FABELLA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INEZ
Authorized Official - Middle Name:G
Authorized Official - Last Name:FABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-687-8200
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G44485Medicare UPIN
ZZZ04983ZMedicare PIN