Individual
KEYLA GISSELLE FAJARDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1151 DOVE ST, NEWPORT BEACH, CA 92660-2840
(949) 630-8290
Mailing address
37548 BANKSIDE DR, CATHEDRAL CITY, CA 92234-7844
(323) 974-0213
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
CA
251S00000X
Community/Behavioral Health Agency
Primary
—
CA
Other
Enumeration date
06/12/2025
Last updated
06/12/2025
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