Individual
BRYAN LEONARDO FIALLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2990
Mailing address
615 W WABASH AVE APT B, EUREKA, CA 95501-2893
(323) 243-3253
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
12/08/2019
Last updated
12/08/2019
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