Healthcare Provider Details

I. General information

NPI: 1184248403
Provider Name (Legal Business Name): RITA FAJARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5858 S PECOS RD # I-100
LAS VEGAS NV
89120-5401
US

IV. Provider business mailing address

5858 S PECOS RD # I-100
LAS VEGAS NV
89120-5401
US

V. Phone/Fax

Practice location:
  • Phone: 702-855-3382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: