Provider Demographics
NPI:1043934524
Name:FAJARDO, ARMIDA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ARMIDA
Middle Name:
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HUNTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1502
Mailing Address - Country:US
Mailing Address - Phone:510-861-5552
Mailing Address - Fax:
Practice Address - Street 1:2250 GLADSTONE DR STE 2
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5124
Practice Address - Country:US
Practice Address - Phone:925-432-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily