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General NPI Number Information
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NPI Number | 1952906356
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Entity Type | Individual
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Provider Name | FERNANDO JUSI SIAZON
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Gender | Male
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 301 MONTARA RD
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City | BARSTOW
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State | CA
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Zip | 92311-5708
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Country | US
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Telephone | 760-252-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4508 CARMEN ST
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City | CHINO
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State | CA
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Zip | 91710-5984
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 83496
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License Number State | CA
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