MATTHEW FAVA

LODI, CA
NPI1821117284
Entity TypeOrganization
Authorized ContactMATTHEW JOSEPH FAVA
Doctor
209-769-9554
Organization Subpart ?No
Primary Taxonomy261QM0801X 
(Licence: CA  47392)
Enumeration Date2007-03-28
Last Update Date2012-04-05
Business Address
MATTHEW FAVA
404 W PINE ST
LODI, CA 95240-2048
Phone number: 209-769-9554
Mailing Address
MATTHEW FAVA
507 YOKUTS DR
LODI, CA 95240-0690
Phone number: 209-769-9554