Individual
JODIE FASULLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
37 OPTIMA, SAN CLEMENTE, CA 92672-9407
(949) 813-3026
Mailing address
37 OPTIMA, SAN CLEMENTE, CA 92672-9407
(949) 813-3026
Taxonomy
Speciality
Code
Description
License number
State
163WN1003X
Nutrition Support Registered Nurse
Primary
718632
CA
Other
Enumeration date
01/29/2019
Last updated
01/29/2019
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