Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 20A13143 | CA |
NPI | 1114286408 |
---|---|
Provider Name | Dr. Cecile Teodoro Fajardo |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2012 |
Last Update Date | 24/05/2018 |