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 1:602 W WILLOW AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6102
Mailing Address - Country:US
Mailing Address - Phone:559-624-2920
Mailing Address - Fax:559-635-4142
Practice Address - Street 1:602 W WILLOW AVE STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6102
Practice Address - Country:US
Practice Address - Phone:559-624-2920
Practice Address - Fax:559-635-4142
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570191835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric