FAUSTO LICONA AYALA

SAN FERNANDO, CA
NPI1588413033
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy171M00000X Case Manager/Care Coordinator
(Licence: CA  16759-RAC)
Enumeration Date2024-05-16
Last Update Date2024-05-16
Business Address
FAUSTO LICONA AYALA
762 GRISWOLD AVE
SAN FERNANDO, CA 91340
Phone number: 747-500-9405
Mailing Address
FAUSTO LICONA AYALA
15120 VICTORY BLVD #6
VAN NUYS, CA 91411
Phone number:
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