Provider Demographics
NPI:1437693603
Name:MURRA, FAWSI JOSE (LAC)
Entity Type:Individual
Prefix:MR
First Name:FAWSI
Middle Name:JOSE
Last Name:MURRA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-4633
Mailing Address - Country:US
Mailing Address - Phone:619-474-8963
Mailing Address - Fax:
Practice Address - Street 1:1639 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-4633
Practice Address - Country:US
Practice Address - Phone:619-474-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8834171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist