Provider Demographics
NPI:1871110916
Name:FESMAN, DAN ERIC III (MT)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:ERIC
Last Name:FESMAN
Suffix:III
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 FOOTHILL BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3518
Mailing Address - Country:US
Mailing Address - Phone:626-926-1246
Mailing Address - Fax:
Practice Address - Street 1:70880 SUNNY LN
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2345
Practice Address - Country:US
Practice Address - Phone:626-926-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist