Individual
EDWARD FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1648 THOMPSON AVE, CHULA VISTA, CA 91913-4340
(619) 414-0069
Mailing address
1648 THOMPSON AVE, CHULA VISTA, CA 91913-4340
(619) 414-0069
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
709679
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
709679
RN
CA
Enumeration date
03/31/2008
Last updated
03/10/2014
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