Active NPI
Peter Fajardo, SUBSTANCE ABUSE COUN
- Addiction (Substance Use Disorder) Counselor
- Long Beach, CA
National Provider Identifier
1033323787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 9223
- Practice address
- 2385 Pacific Avenue
Long Beach, CA 90806 - Phone
- (562) 336-1400
- Fax
- (562) 336-1404
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 9223 | CA | Primary |
Addresses
Primary practice location
2385 Pacific Avenue
Long Beach, CA 90806
Mailing address
P.O. Box 9463
Long Beach, CA 90810
Phone (310) 634-9039
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9223 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1033323787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 9463",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "90810",
"telephone_number": "310-634-9039",
"fax_number": "562-336-1404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2385 PACIFIC AVENUE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "90806",
"telephone_number": "562-336-1400",
"fax_number": "562-336-1404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAJARDO",
"first_name": "PETER",
"name_prefix": "Mr.",
"credential": "SUBSTANCE ABUSE COUN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-10",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "9223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.