Glen Lopez Fajardo, RN
Individual provider Active NPI Registered Nurse · American Canyon, CA
NPI 1386010239 · NPPES record last updated Aug 14, 2015
Key facts
- NPI
- 1386010239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- CA-RN 706582 (CA)
- Practice address
- 335 Summerwood Dr
American Canyon, CA 94503-3184 - Phone
- (707) 656-3252
- NPI assigned
- Aug 14, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CA-RN 706582 | CA | MD | Registered Nurse |
| PHN 79745 | CA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | CA-RN 706582 | CA | Yes |
| Registered Nurse | 163W00000X | PHN 79745 | CA |
Addresses
Primary practice location
335 Summerwood Dr
American Canyon, CA 94503-3184
Mailing address
335 Summerwood Dr
American Canyon, CA 94503-3184
Phone (707) 656-3252
Other providers in American Canyon, CA
- Edmund Perez Dumaguin
- Jaybee Dumaguin
- Mariana Escobar
- Jesenia Espinoza
- Melissa Bree Everitt
- Jennifer Ruezo Fajardo
- Junell Ruezo Fajardo
- Fambyz Enterprise LLC
- Michael Horst Feddersen
- Tania Ivonee Feria Mendez
All providers in American Canyon, CA · Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.