Individual
ETHAN MARK FERGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
908 TUOLUMNE ST, VALLEJO, CA 94590-4641
(707) 648-8121
(707) 648-8129
Mailing address
908 TUOLUMNE ST, VALLEJO, CA 94590-4641
(707) 648-8121
(707) 648-8129
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
CA
172V00000X
Community Health Worker
—
CA
372600000X
Adult Companion
—
—
Other
Enumeration date
09/29/2023
Last updated
05/05/2025
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