Provider Demographics
NPI:1215099353
Name:FASSINO, INC.
Entity type:Organization
Organization Name:FASSINO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:CESAR
Authorized Official - Last Name:FASSINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:949-376-3030
Mailing Address - Street 1:1100 S COAST HWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2968
Mailing Address - Country:US
Mailing Address - Phone:949-376-3030
Mailing Address - Fax:949-376-3028
Practice Address - Street 1:1100 S COAST HWY
Practice Address - Street 2:SUITE 215
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2968
Practice Address - Country:US
Practice Address - Phone:949-376-3030
Practice Address - Fax:949-376-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC019111Medicare ID - Type UnspecifiedMEDICARE
CADC19111Medicare UPIN