Individual
EVELYN JOAN FAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 ACACIA AVE, SAN RAFAEL, CA 94901-2298
(203) 470-6074
Mailing address
50 ACACIA AVE, SAN RAFAEL, CA 94901-2230
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/13/2019
Last updated
04/13/2019
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