Individual
CRISTINA MARIA LARRAZALETA FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12600 CREEKSIDE LN, SUITE 7, FORT MYERS, FL 33919-3353
(239) 343-9220
(239) 343-9231
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9220
(239) 343-9231
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
263509
MA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME126357
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001679700
—
FL
Enumeration date
08/05/2011
Last updated
03/29/2021
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