Provider Demographics
NPI:1255668570
Name:FAJARDO, RAY JASON (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:RAY JASON
Middle Name:
Last Name:FAJARDO
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2275 LAS POSAS RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3344
Mailing Address - Country:US
Mailing Address - Phone:805-388-3732
Mailing Address - Fax:805-987-2904
Practice Address - Street 1:2275 LAS POSAS RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3344
Practice Address - Country:US
Practice Address - Phone:805-388-3732
Practice Address - Fax:805-987-2904
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant