Provider Demographics
NPI:1902879216
Name:FABRIZI, RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:FABRIZI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 AVOCADO AVE STE 709
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8714
Mailing Address - Country:US
Mailing Address - Phone:949-644-5800
Mailing Address - Fax:808-365-5811
Practice Address - Street 1:1401 AVOCADO AVE STE 709
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8714
Practice Address - Country:US
Practice Address - Phone:949-644-5800
Practice Address - Fax:949-644-5813
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63680363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPA16211AMedicare ID - Type Unspecified
CAPA65976Medicare UPIN