Provider Demographics
NPI:1447075536
Name:JABALERA, FAVIAN (CCHW)
Entity type:Individual
Prefix:
First Name:FAVIAN
Middle Name:
Last Name:JABALERA
Suffix:
Gender:M
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 CALLE DEL REY SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-9312
Mailing Address - Country:US
Mailing Address - Phone:505-545-3426
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR ST SE STE 5600
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4920
Practice Address - Country:US
Practice Address - Phone:505-554-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker