| Doctor Name: | MIRASOL FAJARDO |
| NPI Number: | 1174573448 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 15932 |
| Business Practice Address: | 6240 Descanso Ave Buena Park, CA - 906201013 |
| Business Phone Number: | 7145229794 |
| Business Fax Number: | |
| Mailing Address: | 3520 Clarington Ave, LOS ANGELES |
| State: | CA |
| Postal Code: | 900344922 |
| Phone Number: | 3236204617 |
| Fax Number: | |
| NPI Enumeration Date: | 05/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 15932 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |