Individual
MISS JACQUELINE NITA FAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 UCLA MEDICAL PLZ STE 430, LOS ANGELES, CA 90095
(310) 794-7274
(310) 794-7436
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A148664
CA
Other
Enumeration date
04/20/2013
Last updated
10/07/2019
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