Individual
MR. GLEN LOPEZ FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
335 SUMMERWOOD DR, AMERICAN CANYON, CA 94503-3184
(707) 656-3252
Mailing address
335 SUMMERWOOD DR, AMERICAN CANYON, CA 94503-3184
(707) 656-3252
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
CA-RN 706582
CA
163W00000X
Registered Nurse
PHN 79745
CA
Other
Enumeration date
08/14/2015
Last updated
08/14/2015
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