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General NPI Number Information
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NPI Number | 1922146596
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Entity Type | Individual
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Provider Name | KEVIN ANTHONY FAJARDO MD, MPH, MTMH
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Gender | Male
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 2771 HEMLOCK ST STE 100
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City | BREMERTON
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State | WA
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Zip | 98310-2689
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Country | US
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Telephone | 360-360-2763
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Fax | 360-707-7808
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 920-663-9008
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Fax | 920-684-1439
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0061102
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME142177
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 01061083A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD61301063
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License Number State | WA
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