Provider Demographics
NPI:1962126110
Name:FABELO, MOETA ZIARRA
Entity type:Individual
Prefix:
First Name:MOETA
Middle Name:ZIARRA
Last Name:FABELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 RURAL ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-4124
Mailing Address - Country:US
Mailing Address - Phone:810-363-5575
Mailing Address - Fax:
Practice Address - Street 1:157 RURAL ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4124
Practice Address - Country:US
Practice Address - Phone:810-363-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)