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NPI Code Detail

MEDICARE: JORGE FAJARDO

MEDICARE: JORGE FAJARDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1639477193
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE FAJARDO
Provider Business Mailing Address
First Line : 920 E BROADWAY
Second Line :
City : GLENDALE
State : CA
Zip : 91205-1204
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 920 E BROADWAY
Second Line :
City : GLENDALE
State : CA
Zip : 91205-1204
Country : US
Telephone Number : 818-242-8403
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2011
Last Update Date : 03/08/2011

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