Provider Demographics
NPI:1639381387
Name:FAJARDO, MICHELLE ANGELA (DO)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANGELA
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2374 E PACIFICA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6214
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7054
Practice Address - Street 1:24451 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3689
Practice Address - Country:US
Practice Address - Phone:949-452-3053
Practice Address - Fax:949-452-3066
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9558207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA414ZMedicare PIN