Provider Demographics
NPI:1811188600
Name:FAJARDO, MARIA CHERILL CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA CHERILL
Middle Name:CARLOS
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA CHERILL
Other - Middle Name:CARLOS
Other - Last Name:FAJARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6226 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3801
Mailing Address - Country:US
Mailing Address - Phone:310-670-1208
Mailing Address - Fax:310-670-1218
Practice Address - Street 1:6226 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3801
Practice Address - Country:US
Practice Address - Phone:310-670-1208
Practice Address - Fax:310-670-1218
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice