Healthcare Provider Details

I. General information

NPI: 1881857506
Provider Name (Legal Business Name): NATASHA AILIME FAJARDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 SW 71ST ST STE 403
SOUTH MIAMI FL
33143
US

IV. Provider business mailing address

5995 SW 71ST ST STE 403
SOUTH MIAMI FL
33143-3531
US

V. Phone/Fax

Practice location:
  • Phone: 305-894-7400
  • Fax: 305-894-7487
Mailing address:
  • Phone: 305-894-7400
  • Fax: 305-894-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME109623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: