Healthcare Provider Details

I. General information

NPI: 1881743797
Provider Name (Legal Business Name): MARIA CIELO FAJARDO GUTIERREZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

2540 SHORE BLVD APT 2-0
ASTORIA NY
11102-3941
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7272
  • Fax:
Mailing address:
  • Phone: 718-956-0108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number429612-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: