Provider Demographics
NPI:1437313608
Name:FASTENKO, ANNA (CCH)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FASTENKO
Suffix:
Gender:F
Credentials:CCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 MOORPARK AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-4102
Mailing Address - Country:US
Mailing Address - Phone:408-380-3020
Mailing Address - Fax:
Practice Address - Street 1:4020 MOORPARK AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-4102
Practice Address - Country:US
Practice Address - Phone:408-380-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231249209175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath