Healthcare Provider Details

I. General information

NPI: 1609511575
Provider Name (Legal Business Name): SENY MADRIZ FAJARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 SIERRA DR
MODESTO CA
95351-3254
US

IV. Provider business mailing address

16817 MYERS LN
DELHI CA
95315-9259
US

V. Phone/Fax

Practice location:
  • Phone: 209-492-9785
  • Fax: 209-492-9174
Mailing address:
  • Phone: 209-648-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: