Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | A148105 | CA |
N | 2086S0127X | Trauma Surgeon | A148105 | CA |
NPI | 1124301189 |
---|---|
Provider Name | Rafael Torres Fajardo |
First Address | Sacramento, CA 95817-2201 |
Second Address | Sacramento, CA 95817-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2011 |
Last Update Date | 08/12/2020 |