Individual
FAJIE MA II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
123 S COMMERCE ST STE E, STOCKTON, CA 95202-2837
(209) 910-9123
(209) 288-5300
Mailing address
2629 MEADOWBROOK DR, SANTA CLARA, CA 95051-1113
(408) 636-6488
(209) 288-5300
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
944736
NY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
A129917
CA
Other
Enumeration date
09/30/2011
Last updated
10/21/2021
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