Healthcare Provider Details

I. General information

NPI: 1154498798
Provider Name (Legal Business Name): ANA CECILIA FAJARDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/16/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 E CHAPMAN AVE
ORANGE CA
92866-1622
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-2899
  • Fax: 714-289-7062
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA73895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: