Provider Demographics
NPI:1386938421
Name:GABALLA, FADY
Entity type:Individual
Prefix:MR
First Name:FADY
Middle Name:
Last Name:GABALLA
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 1:4247 S MOONEY BLVD
Mailing Address - Street 2:T-1805
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9146
Mailing Address - Country:US
Mailing Address - Phone:559-749-0748
Mailing Address - Fax:559-749-0748
Practice Address - Street 1:4247 S MOONEY BLVD
Practice Address - Street 2:T-1805
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9146
Practice Address - Country:US
Practice Address - Phone:559-749-0748
Practice Address - Fax:559-749-0748
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570191835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric