Healthcare Provider Details

I. General information

NPI: 1245459072
Provider Name (Legal Business Name): AIME FAJARDO CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E TULARE AVE
VISALIA CA
93292-3629
US

IV. Provider business mailing address

5957 S MOONEY BLVD
VISALIA CA
93277-9394
US

V. Phone/Fax

Practice location:
  • Phone: 559-623-0900
  • Fax:
Mailing address:
  • Phone: 559-737-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: