Provider Demographics
NPI:1841375862
Name:FAJARDO, HECTOR
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:FAJARDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 SW 32ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3434
Mailing Address - Country:US
Mailing Address - Phone:786-260-2661
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 79TH AVE STE 162
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1081
Practice Address - Country:US
Practice Address - Phone:305-639-2944
Practice Address - Fax:305-639-2945
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies