Healthcare Provider Details

I. General information

NPI: 1194786509
Provider Name (Legal Business Name): FNA CLINICS OF AMERICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 S SUSAN ST
SANTA ANA CA
92704-8906
US

IV. Provider business mailing address

PO BOX 10076
VAN NUYS CA
91410-0076
US

V. Phone/Fax

Practice location:
  • Phone: 714-427-5430
  • Fax:
Mailing address:
  • Phone: 805-578-8300
  • Fax: 805-578-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291900000X
TaxonomyMilitary Clinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RONALD FERGUSON
Title or Position: PRESIDENT
Credential:
Phone: 714-427-5430