Healthcare Provider Details

I. General information

NPI: 1891056370
Provider Name (Legal Business Name): NOEL R. FAJARDO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S MARYLAND PKWY
LAS VEGAS NV
89119-7537
US

IV. Provider business mailing address

7315 S. PECOS RD SUITE 101
LAS VEGAS NV
89120
US

V. Phone/Fax

Practice location:
  • Phone: 702-982-7240
  • Fax: 702-952-5444
Mailing address:
  • Phone: 702-982-7240
  • Fax: 702-952-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12053
License Number StateNV

VIII. Authorized Official

Name: DR. NOEL RODRIGUEZ FAJARDO
Title or Position: PRESIDENT
Credential: MD
Phone: 702-982-7240