Provider Demographics
NPI:1457077984
Name:FAJARDO MEDICAL LLC
Entity Type:Organization
Organization Name:FAJARDO MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRION OLMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-979-7218
Mailing Address - Street 1:5A18 CALLE 5-2
Mailing Address - Street 2:URB. JARDINES DE MONTE BRISAS
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3115
Mailing Address - Country:US
Mailing Address - Phone:330-979-7218
Mailing Address - Fax:
Practice Address - Street 1:57 CALLE ISABEL ANDREU E
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4806
Practice Address - Country:US
Practice Address - Phone:787-663-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty