Provider Demographics
NPI:1740593029
Name:FALES, KAREN RENEE (MT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:FALES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 DEL REY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5759
Mailing Address - Country:US
Mailing Address - Phone:858-337-8778
Mailing Address - Fax:
Practice Address - Street 1:3517 DEL REY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-5759
Practice Address - Country:US
Practice Address - Phone:858-337-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist