Individual
ANGELINA FAGUNDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
154 S MAIN ST, LAKEPORT, CA 95453-5017
(707) 467-2010
Mailing address
PO BOX 2077, UKIAH, CA 95482-2077
(707) 467-2010
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/15/2018
Last updated
10/15/2018
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