Healthcare Provider Details

I. General information

NPI: 1205406493
Provider Name (Legal Business Name): PATRICIA FAJARDO RN, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2400
US

IV. Provider business mailing address

1828 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2400
US

V. Phone/Fax

Practice location:
  • Phone: 323-859-3617
  • Fax: 323-987-1212
Mailing address:
  • Phone: 323-859-3617
  • Fax: 323-987-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number396321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: