Provider Demographics
NPI:1063050458
Name:GOPIE, FABIAN
Entity type:Individual
Prefix:
First Name:FABIAN
Middle Name:
Last Name:GOPIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 FISHERMANS DR APT H
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-6917
Mailing Address - Country:US
Mailing Address - Phone:954-673-9114
Mailing Address - Fax:
Practice Address - Street 1:10081 NW 3RD CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7049
Practice Address - Country:US
Practice Address - Phone:954-236-4631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician