Active NPI
Alvaro Isip Fajardo
- Speech-Language Assistant
- Brea, CA
National Provider Identifier
1063072387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- 3076
- Practice address
- 500 W Central Ave Ste B
Brea, CA 92821-3036 - Phone
- (714) 529-5022
- NPI assigned
- Jun 18, 2019
- 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 |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | 3076 | CA | Primary |
Addresses
Primary practice location
500 W Central Ave Ste B
Brea, CA 92821-3036
Mailing address
500 W Central Ave Ste B
Brea, CA 92821-3036
Phone (714) 529-5022
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 |
|---|---|---|---|
| 3076 | CA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560816000000",
"number": "1063072387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 W CENTRAL AVE STE B",
"city": "BREA",
"state": "CA",
"postal_code": "928213036",
"telephone_number": "714-529-5022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W CENTRAL AVE STE B",
"city": "BREA",
"state": "CA",
"postal_code": "928213036",
"telephone_number": "714-529-5022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAJARDO",
"first_name": "ALVARO",
"middle_name": "ISIP",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-18",
"last_updated": "2019-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "CA",
"license": "3076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brea, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.