Provider Demographics
NPI:1053023556
Name:MENENDEZ-VEGA, FABIOLA MARIA
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:MARIA
Last Name:MENENDEZ-VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 ROSWELL RD APT 33F
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3949
Mailing Address - Country:US
Mailing Address - Phone:787-675-4211
Mailing Address - Fax:
Practice Address - Street 1:12035 HIGHWAY 92 STE 400
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7010
Practice Address - Country:US
Practice Address - Phone:678-445-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10733111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor