Charese M Fannin, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA12007 Issued in CA

Practice address

3630 East Imperial Highway
Lynwood, CA 90262-2678

Phone

(310) 900-8900

NPI assigned

Jul 10, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: charese.fanninpal.p1@direct.jwch.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Front Line Emergency Care Spec

  • Emergency Medicine Physician
  • Lynwood, CA
  • NPI 1366451080
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430870400000",
    "number": "1770517799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12110",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926852110",
            "telephone_number": "562-809-3571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 EAST IMPERIAL HIGHWAY",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622678",
            "telephone_number": "310-900-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNIN",
        "first_name": "CHARESE",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA12007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA12007",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fairveola Banks
• Fairveola Banks
• Bertha A Fajardo
• Fam Business Management
• Family Healing Center Inc.
• Amin Farah, MD
• Rebecca Farazian, LMFT
• Keila Scarlet Farias
• Farzad Alemi MD Inc
• Sarah Jocelyn Favela

• Medical Physician Assistant in Lynwood, CA
• Providers in Lynwood, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.