Provider Demographics
NPI:1114428810
Name:FAJARDO, MARTHA PATRICIA I
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:PATRICIA
Last Name:FAJARDO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8686 SW 154TH CIRCLE PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1244
Mailing Address - Country:US
Mailing Address - Phone:786-709-6296
Mailing Address - Fax:
Practice Address - Street 1:8686 SW 154 CIRCLE PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3318
Practice Address - Country:US
Practice Address - Phone:786-709-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst