1144486069 NPI number — CHANELLE L. FASBENDER-LOPEZ D.P.T.

Table of content: CHANELLE L. FASBENDER-LOPEZ D.P.T. (NPI 1144486069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144486069 NPI number — CHANELLE L. FASBENDER-LOPEZ D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FASBENDER-LOPEZ
Provider First Name:
CHANELLE
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FASBENDER
Provider Other First Name:
CHANELLE
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.T.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144486069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4505 LAS VIRGENES RD
Provider Second Line Business Mailing Address:
SUITE 103-104
Provider Business Mailing Address City Name:
CALABASAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91302-1956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-880-4758
Provider Business Mailing Address Fax Number:
818-880-4781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4505 LAS VIRGENES RD
Provider Second Line Business Practice Location Address:
SUITE 103-104
Provider Business Practice Location Address City Name:
CALABASAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91302-1956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-880-4758
Provider Business Practice Location Address Fax Number:
818-880-4781
Provider Enumeration Date:
07/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT34748 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com