Provider Demographics
NPI:1558540138
Name:FAJARDO, CYNTHIA LIZET (MS, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:LIZET
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1948 EMERALD ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3563
Mailing Address - Country:US
Mailing Address - Phone:619-459-7468
Mailing Address - Fax:619-758-9589
Practice Address - Street 1:5022 W POINT LOMA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-1313
Practice Address - Country:US
Practice Address - Phone:619-780-8215
Practice Address - Fax:619-758-9589
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13212103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst