Individual
MS. FAIRIN I ANTONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN II
Contact information
Practice address
15145 A LAKESHORE DR, CLEARLAKE, CA 95422
(707) 994-7090
(707) 994-7096
Mailing address
5029 WINTUN WAY, KELSEYVILLE, CA 95451-9690
(707) 277-7667
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN169534
CA
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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