Glen Lopez Fajardo, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

CA-RN 706582 Issued in CA

Practice address

335 Summerwood Dr
American Canyon, CA 94503-3184

Phone

(707) 656-3252

NPI assigned

Aug 14, 2015

Last updated

Aug 14, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439510400000",
    "number": "1386010239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 SUMMERWOOD DR",
            "city": "AMERICAN CANYON",
            "state": "CA",
            "postal_code": "945033184",
            "telephone_number": "707-656-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 SUMMERWOOD DR",
            "city": "AMERICAN CANYON",
            "state": "CA",
            "postal_code": "945033184",
            "telephone_number": "707-656-3252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAJARDO",
        "first_name": "GLEN",
        "middle_name": "LOPEZ",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-14",
        "last_updated": "2015-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "CA-RN 706582",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "PHN 79745",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edmund Perez Dumaguin, RN,BSN
• Jaybee Dumaguin
• Mariana Escobar
• Jesenia Espinoza
• Melissa Bree Everitt, PHARM.D.
• Jennifer Ruezo Fajardo, RN
• Junell Ruezo Fajardo, RN
• Fambyz Enterprise LLC
• Michael Horst Feddersen, D.O.
• Tania Ivonee Feria Mendez, RBT

• Registered Nurse in American Canyon, CA
• Providers in American Canyon, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.