Individual
MR. TROY G FAJERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
632 W GIBSON RD, WOODLAND, CA 95695
(530) 666-1631
Mailing address
632 W GIBSON RD, WOODLAND, CA 95695
(530) 666-1631
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA12188
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00061967
RR MEDICARE
CA
01
—
PA12188
MEDI-CAL
CA
Enumeration date
07/18/2006
Last updated
10/30/2013
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