Provider Demographics
NPI:1346259769
Name:FAJARDO, CESAR BENEDICT (DPT)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:BENEDICT
Last Name:FAJARDO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 E CARITA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2556
Mailing Address - Country:US
Mailing Address - Phone:626-340-9200
Mailing Address - Fax:
Practice Address - Street 1:3662 KATELLA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3124
Practice Address - Country:US
Practice Address - Phone:562-799-4494
Practice Address - Fax:562-280-0304
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT32157AMedicare ID - Type Unspecified