Provider Demographics
NPI:1063097731
Name:HAYABE, FABIO ISSAMU (RN)
Entity type:Individual
Prefix:MR
First Name:FABIO
Middle Name:ISSAMU
Last Name:HAYABE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5002 TUJUNGA AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-5014
Mailing Address - Country:US
Mailing Address - Phone:323-449-5270
Mailing Address - Fax:
Practice Address - Street 1:435 ARDEN AVE STE 560
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1142
Practice Address - Country:US
Practice Address - Phone:818-725-1025
Practice Address - Fax:888-863-5290
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA758593163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA758593OtherCALIFORNIA BOARD OF REGISTERED NURSING- BRN