Individual
RAUL FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
31895 SUN KETTLE LOOP, WESLEY CHAPEL, FL 33545-2252
(561) 389-0672
Mailing address
31895 SUN KETTLE LOOP, WESLEY CHAPEL, FL 33545-2252
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013682800
—
FL
Enumeration date
09/20/2021
Last updated
09/20/2021
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