Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A138953 | CA |
NPI | 1003236845 |
---|---|
Provider Name | Jesus Fajardo |
First Address | Pomona, CA 91767-1923 |
Second Address | Pomona, CA 91767-1923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2014 |
Last Update Date | 01/09/2020 |