Provider Demographics
NPI:1205131083
Name:FAJARDO ANGELES, RACHEL (DMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:FAJARDO ANGELES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:PATRICIA
Other - Last Name:FAJARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1238 MENDEZ DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5620
Mailing Address - Country:US
Mailing Address - Phone:714-206-2043
Mailing Address - Fax:
Practice Address - Street 1:2005 W HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768
Practice Address - Country:US
Practice Address - Phone:909-623-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABF61428661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice