Individual
MR. JORDAN FASANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
31269 MANGROVE DR., TEMECULA, CA 92592
(858) 337-4122
Mailing address
31269 MANGROVE DR, TEMECULA, CA 92592
(858) 337-4122
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
257921
CA
Other
Enumeration date
06/15/2011
Last updated
06/15/2011
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