Provider Demographics
NPI:1881857506
Name:FAJARDO, NATASHA AILIME (MD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:AILIME
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5995 SW 71ST ST STE 403
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3531
Mailing Address - Country:US
Mailing Address - Phone:305-894-7400
Mailing Address - Fax:305-894-7487
Practice Address - Street 1:5995 SW 71ST ST STE 403
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-894-7400
Practice Address - Fax:305-894-7487
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 109623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine