Provider Demographics
NPI:1760279863
Name:FABULAR, ANGELICA VANESSA (RBT)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:VANESSA
Last Name:FABULAR
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 HAYES DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3706
Mailing Address - Country:US
Mailing Address - Phone:626-224-7196
Mailing Address - Fax:
Practice Address - Street 1:2550 HAYES DR
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3706
Practice Address - Country:US
Practice Address - Phone:626-224-7196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty