Healthcare Provider Details

I. General information

NPI: 1104390376
Provider Name (Legal Business Name): EPHRAIM PAJARILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NEVIN AVE
RICHMOND CA
94801-3143
US

IV. Provider business mailing address

1231 HALSEY ST
VALLEJO CA
94590-3065
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-1500
  • Fax:
Mailing address:
  • Phone: 707-853-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number33112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: