Individual
CHRISTAL LA SHAWN FENNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
17223 CERRITOS ST, FONTANA, CA 92336-1584
(909) 241-6333
Mailing address
10935 TERRA VISTA PKWY APT 83, RANCHO CUCAMONGA, CA 91730-6348
(909) 484-3968
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN220919
CA
Other
Enumeration date
04/16/2007
Last updated
05/08/2025
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