Individual
CHARESE M FANNIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3630 EAST IMPERIAL HIGHWAY, LYNWOOD, CA 90262-2678
(310) 900-8900
Mailing address
PO BOX 12110, WESTMINSTER, CA 92685-2110
(562) 809-3571
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA12007
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA12007
—
CA
Enumeration date
07/10/2006
Last updated
05/06/2015
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