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NPI Code Detail

MEDICARE: DR. ALISHA RHEA FAJARDO O.D.

MEDICARE: DR. ALISHA RHEA FAJARDO O.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
1152W00000XOptometrist1692AZ

General Provider Information

NPI Number : 1831328764
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALISHA RHEA FAJARDO O.D.
Provider Business Mailing Address
First Line : 220 N MCKEMY AVE
Second Line :
City : CHANDLER
State : AZ
Zip : 85226-2654
Country : US
Telephone Number : 480-835-4472
Fax Number : 480-893-8172
Provider Business Practice Location Address
First Line : 1175 S ARIZONA AVE
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-6504
Country : US
Telephone Number : 480-726-0941
Fax Number : 480-726-0943
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2009
Last Update Date : 08/23/2016

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