Provider Demographics
NPI:1639432545
Name:FAJARDO GOMEZ, OSCAR SAUL (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:SAUL
Last Name:FAJARDO GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N DOUTY STREET
Mailing Address - Street 2:BEHAVIORAL HEALTH
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-537-0246
Mailing Address - Fax:
Practice Address - Street 1:1025 N DOUTY STREET
Practice Address - Street 2:BEHAVIORAL HEALTH
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-537-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4587332084P0800X
CAA1456392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry