Individual
CAROLYN FASAKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2180 VALLEY BLVD, POMONA, CA 91768-3325
(909) 865-2336
Mailing address
16260 WIND FOREST WAY, CHINO HILLS, CA 91709-4649
(909) 569-9491
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
760974
CA
Other
Enumeration date
04/09/2019
Last updated
04/09/2019
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