Healthcare Provider Details

I. General information

NPI: 1669402756
Provider Name (Legal Business Name): CARLOS FAJARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE 375
PHOENIX AZ
85013-3420
US

IV. Provider business mailing address

300 W CLARENDON AVE 375
PHOENIX AZ
85013-3420
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-4161
  • Fax: 602-274-3394
Mailing address:
  • Phone: 602-277-4161
  • Fax: 602-274-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25269
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25269
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: