Healthcare Provider Details

I. General information

NPI: 1043934524
Provider Name (Legal Business Name): ARMIDA FAJARDO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 GLADSTONE DR STE 2
PITTSBURG CA
94565-5124
US

IV. Provider business mailing address

255 HUNTLEY AVE
MOUNTAIN HOUSE CA
95391-1502
US

V. Phone/Fax

Practice location:
  • Phone: 925-432-6208
  • Fax:
Mailing address:
  • Phone: 510-861-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: