Provider Demographics
NPI:1063400158
Name:FAUBLAS, JOSIANE M (MD)
Entity type:Individual
Prefix:
First Name:JOSIANE
Middle Name:M
Last Name:FAUBLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-486-8020
Mailing Address - Fax:954-486-8983
Practice Address - Street 1:4400 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5862
Practice Address - Country:US
Practice Address - Phone:954-486-8020
Practice Address - Fax:954-486-8983
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME69866208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379319200Medicaid