Individual
MR. EUGENIO FAJARDO REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3261 W SARGENT RD, LODI, CA 95242-9212
(925) 963-7957
(209) 369-7010
Mailing address
3261 W SARGENT RD, LODI, CA 95242-9212
(925) 963-7957
(209) 369-7010
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
PENDING
CA
Other
Enumeration date
07/23/2008
Last updated
07/23/2008
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