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General NPI Number Information
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NPI Number | 1619479466
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Entity Type | Individual
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Provider Name | MARIO JOAQUIN FAJARDO D.O. (DISPENSING OPT
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Gender | Male
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2935 OSWELL ST STE B
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City | BAKERSFIELD
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State | CA
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Zip | 93306-2705
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Country | US
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Telephone | 661-912-4058
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12832
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City | BAKERSFIELD
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State | CA
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Zip | 93389-2832
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Country | US
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Telephone | 661-912-4058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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