Organization Active NPI

Gabriel T Fabella MD Inc

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1821497066
Registry record updated Aug 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A48087 Issued in CA
Legal business name
GABRIEL T FABELLA MD INC
Practice address
10737 Camino Ruiz
Suite 115
San Diego, CA 92126-2359
Phone
(858) 695-1262
Fax
(858) 695-2132
NPI assigned
Aug 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gabriel T Fabella, M.D.NPI 1124060827
Title
President
Phone
(858) 695-1262

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X A48087 CA Primary

Addresses

Primary practice location

10737 Camino Ruiz
Suite 115
San Diego, CA 92126-2359

Mailing address

10737 Camino Ruiz
Suite 115
San Diego, CA 92126-2359
Phone (858) 695-1262

Other identifiers 1

IdentifierTypeStateIssuer
A48087OtherCALICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040721001150 CA Part B Supplier - Clinic/Group Practice 4981680121 Receives reassigned benefits from 1 practitioner
Practice locations: San Diego, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1038443Gabriel T Fabella MD Inc10737 Camino Ruiz 115, San Diego, CA 92126Certificate of waiverMar 17, 2027

National Provider Directory

National Provider Directory

Locations

10737 Camino Ruiz
San Diego, CA 92126
Phone (858) 536-7799

10737 Camino Ruiz
Ste 115
San Diego, CA 92126
Phone (858) 695-1262

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407888000000",
    "number": "1821497066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10737 CAMINO RUIZ",
            "address_2": "SUITE 115",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921262359",
            "telephone_number": "858-695-1262",
            "fax_number": "858-695-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10737 CAMINO RUIZ",
            "address_2": "SUITE 115",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921262359",
            "telephone_number": "858-695-1262",
            "fax_number": "858-695-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GABRIEL T FABELLA MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-13",
        "last_updated": "2014-08-13",
        "status": "A",
        "authorized_official_last_name": "FABELLA",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-695-1262",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A48087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "A48087",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.