Provider Demographics
NPI:1083776496
Name:FASSINO, JULIO CESAR (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:CESAR
Last Name:FASSINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20321 SW ACACIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1762
Mailing Address - Country:US
Mailing Address - Phone:949-293-9753
Mailing Address - Fax:949-209-3701
Practice Address - Street 1:20321 SW ACACIA ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1762
Practice Address - Country:US
Practice Address - Phone:949-293-9753
Practice Address - Fax:949-209-3701
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC019111Medicare ID - Type UnspecifiedMEDICARE
CADC19111Medicare UPIN