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Individual

DAREK RAY FONDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2862 CANYON SPRINGS PKWY, RIVERSIDE, CA 92507-0928
(310) 344-7632
Mailing address
41805 JENNIFER AVE, HEMET, CA 92544-8304

Taxonomy

Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
93206
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
93206
CA
Enumeration date
08/14/2020
Last updated
08/14/2020
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