Provider Demographics
NPI:1205406493
Name:FAJARDO, PATRICIA (RN, MPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:RN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2400
Mailing Address - Country:US
Mailing Address - Phone:323-859-3617
Mailing Address - Fax:323-987-1212
Practice Address - Street 1:1828 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2400
Practice Address - Country:US
Practice Address - Phone:323-859-3617
Practice Address - Fax:323-987-1212
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396321163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health