Healthcare Provider Details

I. General information

NPI: 1124582630
Provider Name (Legal Business Name): LORIE J FAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E COMPTON BLVD FL 1
COMPTON CA
90221-3303
US

IV. Provider business mailing address

921 E COMPTON BLVD FL 1
COMPTON CA
90221-3303
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-6912
  • Fax: 310-223-0694
Mailing address:
  • Phone: 310-668-6912
  • Fax: 310-223-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: