Provider Demographics
NPI:1346767647
Name:FASULO, CHRISTOPHER FRANK (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:FRANK
Last Name:FASULO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:FRANK
Other - Last Name:FASULO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:9263 N SAYBROOK DR APT 250
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0824
Mailing Address - Country:US
Mailing Address - Phone:480-818-3519
Mailing Address - Fax:
Practice Address - Street 1:344 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-3631
Practice Address - Country:US
Practice Address - Phone:559-664-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant