Provider Demographics
NPI:1881908093
Name:FLETCHER, AJARRAH
Entity type:Individual
Prefix:
First Name:AJARRAH
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AJARRAH
Other - Middle Name:
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19401 S VERMONT AVE
Mailing Address - Street 2:A-200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1029
Mailing Address - Country:US
Mailing Address - Phone:310-323-6887
Mailing Address - Fax:310-436-8285
Practice Address - Street 1:19401 S VERMONT AVE
Practice Address - Street 2:A-200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1029
Practice Address - Country:US
Practice Address - Phone:310-323-6887
Practice Address - Fax:310-436-8285
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner