Basic Information
| Provider Information | |||||||||
| NPI: | 1902879216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FABRIZI | ||||||||
| FirstName: | RENEE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-184 HUALALAI RD | ||||||||
| Address2: | STE 302 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083290111 | ||||||||
| FaxNumber: | 8083655811 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 NEWPORT CENTER DR | ||||||||
| Address2: | SUITE 650 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496445800 | ||||||||
| FaxNumber: | 9496445813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 06/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA16211 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.