1144659459

Everything you always wanted to know about MR. CHACON JON FREDERICK but were afraid to ask.

MR. CHACON JON FREDERICK

You can also download the this 1144659459 data report as csv | excel | json | xml
Provider Prefix Provider Last Name Provider Middle Name Provider First Name
MR. CHACON JON FREDERICK
Gender:
Male
Enumeration date:
2013-11-06
Last update date:
2017-07-03
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state
19122731 Other MEDICAL CA

Taxonomies

Taxonomy State License Number Primary?
101Y00000X Counselor none none
101YS0200X School CA IMF77897

Phone Numbers

Type Number
Practice Location Address Telephone Number 6262277014
Practice Location Address Fax Number 6262277015
Mailing Address Telephone Number (626) 395-7100
Mailing Address Fax Number 6266852126

Addresses

Type Address City State Postal Country
Mailing Address 210 S DE LACEY AVE PASADENA CA 91105 CA
Practice Location Address 2523 W 7TH ST SUITE 110 LOS ANGELES CA 0 CA

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1710353354 ROMAN, EDGAR
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160 S 7TH AVE CA LA PUENTE
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