Individual
MR. FARGO MICHAEL LIVINGSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.A.
Contact information
Practice address
717 LINCOLN BLVD, VENICE, CA 90291-2845
(310) 399-9883
(131) 039-9967
Mailing address
717 LINCOLN BLVD, VENICE, CA 90291
(310) 399-9883
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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