Individual
JAESON M FETALVERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7246 REMMET AVE, CANOGA PARK, CA 91303-1531
(818) 206-0630
Mailing address
3834 COLMA AVE, MERCED, CA 95348-8719
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
218256
CA
Other
Enumeration date
08/18/2020
Last updated
05/21/2021
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