Healthcare Provider Details

I. General information

NPI: 1790990877
Provider Name (Legal Business Name): CYNTHIA DAWN FAJMON LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 FLORES LANE
PASCO WA
99301
US

IV. Provider business mailing address

4915 FLORES LN
PASCO WA
99301-7909
US

V. Phone/Fax

Practice location:
  • Phone: 509-860-3576
  • Fax:
Mailing address:
  • Phone: 509-860-3576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00022178
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: