Individual
STEPHEN FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5472 GENEVA AVE, SAN DIEGO, CA 92114-1121
(619) 961-8526
Mailing address
5472 GENEVA AVE, SAN DIEGO, CA 92114-1121
(619) 961-8526
Taxonomy
Speciality
Code
Description
License number
State
246ZX2200X
Orthopedic Assistant
Primary
07-1142
CA
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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