Individual
MIRASOL FAJARDO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
6240 DESCANSO AVE, BUENA PARK, CA 90620-1013
(714) 522-9794
Mailing address
3520 CLARINGTON AVE, LOS ANGELES, CA 90034-4922
(323) 620-4617
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
15932
CA
Other
Enumeration date
05/10/2006
Last updated
07/08/2007
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