Individual
MR. CHARLES PHILLIP ANDREW FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
23701 E EAST FORK RD, AZUSA, CA 91702-1477
(626) 250-3290
Mailing address
1090 FREMONT ST, POMONA, CA 91766-5028
(909) 631-7386
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/12/2015
Last updated
05/12/2015
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