Provider Demographics
NPI:1497992259
Name:FAHEY, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FAHEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6706 CAMELLIA AVE # A-2
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1743
Mailing Address - Country:US
Mailing Address - Phone:818-804-7643
Mailing Address - Fax:
Practice Address - Street 1:14411 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4038
Practice Address - Country:US
Practice Address - Phone:818-989-7475
Practice Address - Fax:818-908-2434
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner