Active NPI
Mirasol Fajardo, N.P.
- Adult Health Nurse Practitioner
- Buena Park, CA
National Provider Identifier
1174573448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 15932
- Practice address
- 6240 Descanso Ave
Buena Park, CA 90620-1013 - Phone
- (714) 522-9794
- NPI assigned
- May 10, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 15932 | CA | Primary |
Addresses
Primary practice location
6240 Descanso Ave
Buena Park, CA 90620-1013
Mailing address
3520 Clarington Ave
Los Angeles, CA 90034-4922
Phone (323) 620-4617
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15932 | CA | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1174573448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3520 CLARINGTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900344922",
"telephone_number": "323-620-4617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6240 DESCANSO AVE",
"city": "BUENA PARK",
"state": "CA",
"postal_code": "906201013",
"telephone_number": "714-522-9794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAJARDO",
"first_name": "MIRASOL",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-10",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "CA",
"license": "15932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buena Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.