Healthcare Provider Details

I. General information

NPI: 1942872155
Provider Name (Legal Business Name): ANA FAJARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 FLORIDA KEYS DR
LAS VEGAS NV
89156-4929
US

IV. Provider business mailing address

2605 FLORIDA KEYS DR
LAS VEGAS NV
89156-4929
US

V. Phone/Fax

Practice location:
  • Phone: 702-581-2916
  • 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: