Jaeson M Fetalvero, is a
Licensed Practical Nurse based in Canoga Park, California. Jaeson M Fetalvero is licensed to practice in California (license number 218256) and his current practice location is
7246 Remmet Ave, Canoga Park, California. He can be reached at his office (for appointments etc.) via phone at
(818) 206-0630.
NPI number for Jaeson M Fetalvero is 1356953848 and his current mailing address is 3834 Colma Ave, Merced, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1356953848.
Provider's Profile
| Full Name | Jaeson M Fetalvero |
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| Gender | Male |
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| Speciality | Licensed Practical Nurse |
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| Location | 7246 Remmet Ave, Canoga Park, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1356953848
- Provider Enumeration Date: 08/18/2020
- Last Update Date: 05/21/2021
Medical Identifiers
Medical identifiers for Jaeson M Fetalvero such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1356953848 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 164W00000X | Licensed Practical Nurse | 218256 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jaeson M Fetalvero is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jaeson M Fetalvero,
3834 Colma Ave,
Merced, CA 95348-8719
Ph: () - | Jaeson M Fetalvero,
7246 Remmet Ave,
Canoga Park, CA 91303-1531
Ph: (818) 206-0630 |
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