Healthcare Provider Details

I. General information

NPI: 1679892160
Provider Name (Legal Business Name): OLGA ESTHER FAJARDO CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 W FLAGLER ST
CORAL GABLES FL
33134-1604
US

IV. Provider business mailing address

11031 NE 6TH AVE
MIAMI FL
33161-7182
US

V. Phone/Fax

Practice location:
  • Phone: 305-774-3600
  • Fax: 305-476-2640
Mailing address:
  • Phone: 305-398-6100
  • Fax: 305-757-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCNA42813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: