Provider Demographics
NPI:1912618778
Name:WAHL-FABREGA, TAYLOR (RD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WAHL-FABREGA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E CEDAR AVE STE 26
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1642
Mailing Address - Country:US
Mailing Address - Phone:928-773-1245
Mailing Address - Fax:928-773-9429
Practice Address - Street 1:1500 E CEDAR AVE STE 26
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1642
Practice Address - Country:US
Practice Address - Phone:602-717-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86297772133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered