Provider Demographics
NPI:1770876690
Name:FAJEMISIN, REKIAT F (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:REKIAT
Middle Name:F
Last Name:FAJEMISIN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 PLUM TREE PL
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5719
Mailing Address - Country:US
Mailing Address - Phone:310-621-3465
Mailing Address - Fax:
Practice Address - Street 1:7261 PLUM TREE PL
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5719
Practice Address - Country:US
Practice Address - Phone:310-621-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 343124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist