Provider Demographics
NPI:1831446475
Name:PARKER, ROXANA FAJARDO (LMFT)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:FAJARDO
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ROXANA
Other - Middle Name:FAJARDO
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27349 JEFFERSON AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5610
Mailing Address - Country:US
Mailing Address - Phone:949-201-8260
Mailing Address - Fax:
Practice Address - Street 1:27349 JEFFERSON AVE STE 111
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5610
Practice Address - Country:US
Practice Address - Phone:949-201-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150391106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator