Individual
GABRIEL FAJARDO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4599
(208) 422-1092
Mailing address
1622 W TETON AVE, NAMPA, ID 83686-4820
(208) 422-1092
Taxonomy
Speciality
Code
Description
License number
State
163WG0100X
Gastroenterology Registered Nurse
Primary
60578
ID
Other
Enumeration date
10/31/2025
Last updated
10/31/2025
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