Provider Demographics
NPI:1851510549
Name:FAGUNDES, MARCO
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:
Last Name:FAGUNDES
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARC
Other - Middle Name:PAUL
Other - Last Name:FAGUNDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1221 FULTON MALL
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1915
Mailing Address - Country:US
Mailing Address - Phone:559-445-3449
Mailing Address - Fax:559-445-3370
Practice Address - Street 1:1221 FULTON MALL
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1915
Practice Address - Country:US
Practice Address - Phone:559-445-3449
Practice Address - Fax:559-445-3370
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493045163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse