Organization
MICHAEL K FAIRBANKS DPM A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL K FAIRBANKS DPM (SOLE OWNER)
(619) 465-4972
Entity
Organization
Contact information
Practice address
425 W BONITA AVE, SUITE 110, SAN DIMAS, CA 91773-2541
(909) 599-0981
(909) 592-0738
Mailing address
7750 EASTRIDGE DR, LA MESA, CA 91941-7882
(619) 465-4972
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E2726
CA
Other
Enumeration date
08/24/2011
Last updated
11/09/2016
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