Basic Information
| Provider Information | |||||||||
| NPI: | 1336776145 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERNA | ||||||||
| FirstName: | FABIANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | PROF. | ||||||||
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| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 E MARKET ST APT 808 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462042895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6463618352 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 535 BARNHILL DR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179486942 | ||||||||
| FaxNumber: | 3179489302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2020 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | IN | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.