Healthcare Provider Details

I. General information

NPI: 1821928524
Provider Name (Legal Business Name): ZAIRA J FAJARDO CBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22021 7TH AVE S STE 205
DES MOINES WA
98198-6218
US

IV. Provider business mailing address

22021 7TH AVE S STE 205
DES MOINES WA
98198-6218
US

V. Phone/Fax

Practice location:
  • Phone: 719-623-9179
  • Fax: 253-354-0039
Mailing address:
  • Phone: 719-623-9179
  • Fax: 253-354-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCBT.CB.70113105
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: