# JERRY M FABRIKANT DPM, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851578819
- **Authorized official:** JERRY M FABRIKANT DPM (PRESIDENT)
- **Authorized official phone:** (619) 465-3443

## Contact information

- **Practice address:** 5565 GROSSMONT CENTER DR STE 3, STE 353, LA MESA, CA 91942-3007
- **Practice address phone:** (619) 465-3443
- **Practice address fax:** (619) 466-7311
- **Mailing address:** 5565 GROSSMONT CENTER DR, BLDG 3 STE 353, LA MESA, CA 91942-3020
- **Mailing address phone:** (619) 465-3443
- **Mailing address fax:** (619) 466-7311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | — | NULL | — |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 01/22/2008
- **Last updated:** 06/19/2013