Organization
JERRY M FABRIKANT DPM, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY M FABRIKANT DPM (PRESIDENT)
(619) 465-3443
Entity
Organization
Contact information
Practice address
5565 GROSSMONT CENTER DR STE 3, STE 353, LA MESA, CA 91942-3007
(619) 465-3443
(619) 466-7311
Mailing address
5565 GROSSMONT CENTER DR, BLDG 3 STE 353, LA MESA, CA 91942-3020
(619) 465-3443
(619) 466-7311
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Enumeration date
01/22/2008
Last updated
06/19/2013
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