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Individual
DR. MANUEL LICITRA FAJARDO
Active
Individual
DR. MANUEL LICITRA FAJARDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
279410
NY
207R00000X
Internal Medicine Physician
53519
CT
208M00000X
Hospitalist Physician
279410
NY
208M00000X
Hospitalist Physician
53519
CT
Other
Enumeration date
01/30/2012
Last updated
01/23/2024
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