Provider Demographics
NPI:1558448241
Name:FAJARDO, MARIA LUISA (RN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIA LUISA
Other - Middle Name:FRANCISCO
Other - Last Name:FAJARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2647 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3570
Mailing Address - Country:US
Mailing Address - Phone:951-278-8207
Mailing Address - Fax:
Practice Address - Street 1:9990 COUNTY FARM RD
Practice Address - Street 2:SUITE 3
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3542
Practice Address - Country:US
Practice Address - Phone:951-358-4647
Practice Address - Fax:951-358-5363
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN498850163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent