Active NPI
Robert R Fajardo, PA
- Medical Physician Assistant
- Redlands, CA
National Provider Identifier
1194789750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA10610
- Practice address
- 2 W. Fern Ave.
Redlands, CA 92373-5916 - Phone
- (909) 793-3311
- Fax
- (909) 307-9469
- NPI assigned
- Apr 12, 2006
- Last updated
- Feb 25, 2009
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA10610 | CA | Primary |
Addresses
Primary practice location
2 W. Fern Ave.
Redlands, CA 92373-5916
Mailing address
P.O. Box 2200
Redlands, CA 92373-0722
Phone (909) 793-3311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10610 | CA | MD | Physical Rehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235520000000",
"number": "1194789750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 2200",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923730722",
"telephone_number": "909-793-3311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 W. FERN AVE.",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923735916",
"telephone_number": "909-793-3311",
"fax_number": "909-307-9469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAJARDO",
"first_name": "ROBERT",
"middle_name": "R",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-12",
"last_updated": "2009-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA10610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
- Faculty Physicians and Surgeons of Llusm
- Faculty Physicians and Surgeons of Llusm
- Faculty Physicians and Surgeons of Llusm
- Faculty Physicians and Surgeons of Llusm
- Noura Fadel, D.D.S. FAGD
- Sabrina Fakhoury, APCC
- Elizabeth K Falk, PTA
- Brianna Fallon
- Family First Ventures Inc. (Home Instead)
- Family Primary and Specialty Care Clinic
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.