MEDICARE: REBECA FAJARDO M.D.

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	207R00000X	Internal Medicine Physician	ME106105	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME106105	OTHER	FL	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477682045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECA FAJARDO M.D.

Provider Business Mailing Address
First Line	:	6101 WEBB RD STE 203
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2865
Country	:	US
Telephone Number	:	813-269-6426
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 WEBB RD STE 203
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2865
Country	:	US
Telephone Number	:	813-269-6426
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	05/19/2020

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