MEDICARE: KASSANDRA FAJARDO-GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA 9240	FL

General Provider Information

NPI Number	:	1053781435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA FAJARDO-GARCIA

Provider Business Mailing Address
First Line	:	300 SEVILLA AVE STE 300
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6636
Country	:	US
Telephone Number	:	786-512-8323
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SEVILLA AVE STE 300
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6636
Country	:	US
Telephone Number	:	786-512-8323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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Directions to “ KASSANDRA FAJARDO-GARCIA ” Practice Location

Language	Start Address	Practice Location

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