Provider Demographics
NPI:1033820154
Name:FAJARDO ALGARIN, CHRISTIAN R
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:R
Last Name:FAJARDO ALGARIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4040
Mailing Address - Street 2:SUITE 450
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-7040
Mailing Address - Country:US
Mailing Address - Phone:787-249-7793
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA FINAL # 40
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-600-2290
Practice Address - Fax:787-712-3427
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR90452164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse