Healthcare Provider Details

I. General information

NPI: 1114651783
Provider Name (Legal Business Name): KARLA V FAJARDO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8713 HIDDEN PINES AVE
LAS VEGAS NV
89143-1366
US

IV. Provider business mailing address

8713 HIDDEN PINES AVE
LAS VEGAS NV
89143-1366
US

V. Phone/Fax

Practice location:
  • Phone: 702-553-8492
  • Fax:
Mailing address:
  • Phone: 702-553-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number856247
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: