Individual
JODIVON LEE FAIRCLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
5300 ANGELES VISTA BLVD, VIEW PARK, CA 90043-1648
(323) 295-4555
Mailing address
512 GRACE AVE APT 1, INGLEWOOD, CA 90301-1339
(424) 541-8364
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN716238
CA
Other
Enumeration date
06/04/2021
Last updated
06/04/2021
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