Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 231249209 | CA |
NPI | 1437313608 |
---|---|
Provider Name | Anna Fastenko |
First Address | San Jose, CA 95117-4102 |
Second Address | San Jose, CA 95117-4102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 16/07/2008 |