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1164985677
WAYNE FONDREN
BLOOMINGTON, CA
NPI
1164985677
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-04-11
Last Update Date
2019-04-11
Business Address
WAYNE FONDREN
18612 SANTA ANA AVE
BLOOMINGTON, CA 92316-2639
Phone number: 909-421-7120
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Mailing Address
WAYNE FONDREN
18612 SANTA ANA AVE
BLOOMINGTON, CA 92316-2639
Phone number: 909-421-7120
Copy
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