# FAJARDO MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457077984
- **Authorized official:** CARLY CARRION OLMEDA MD (PHYSICIAN)
- **Authorized official phone:** (330) 979-7218

## Contact information

- **Practice address:** 57 CALLE ISABEL ANDREU E, FAJARDO, PR 00738-4806
- **Practice address phone:** (787) 663-6770
- **Mailing address:** 5A18 CALLE 5-2, URB. JARDINES DE MONTE BRISAS, FAJARDO, PR 00738-3115
- **Mailing address phone:** (330) 979-7218

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RB0002X | Obesity Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RB0002X | Obesity Medicine (Internal Medicine) Physician | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 2083B0002X | Obesity Medicine (Preventive Medicine) Physician | — | NULL | — |
| 2083B0002X | Obesity Medicine (Preventive Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 10/17/2022
- **Last updated:** 01/31/2024