Charese M Fannin, PA
Physician Assistant, Medical in Lynwood, CA. Individual provider (NPI-1).
NPI number1770517799
StatusActive
Last updated in NPPESMay 6, 2015
Details
- NPI
- 1770517799
- Entity type
- Individual (NPI-1)
- Name
- Charese M Fannin
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 10, 2006
- Last updated
- May 6, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | PA12007 | CA | Yes |
Practice location
3630 East Imperial HighwayLynwood, CA 90262-2678
Phone 310-900-8900
Mailing address
Po Box 12110Westminster, CA 92685-2110
Phone 562-809-3571
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Other Medical Physician Assistant providers in Lynwood, CA
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All 9 Medical Physician Assistant providers in Lynwood · All 1,430 providers in Lynwood
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