An Phan Fajardo

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

295871 Issued in CA

Practice address

16921 Taylor CT
Torrance, CA 90504-2213

Phone

(310) 292-8179

NPI assigned

Nov 8, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Goodlife Physical Medicine CorpGroup PAC ID 0446542922, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: an.fajardo.1@22164.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Goodlife Physical Medicine Corp

  • General Practice Physician
  • Redondo Beach, CA
  • NPI 1891152781
  Medicare reassignment Care Compare group NPD
• Lotus Physical Therapy Inc

  • Physical Therapist
  • Los Angeles, CA
  • NPI 1609862606
  Medicare reassignment NPD
• Goodlife Physical Medicine Corp

  • General Practice Physician
  • Torrance, CA
  • NPI 1275229692
  NPD
• Dynamik Rehab Inc

  • Physical Therapist
  • Garden Grove, CA
  • NPI 1720806417
  NPD (past)

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

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1659849412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16921 TAYLOR CT",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905042213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16921 TAYLOR CT",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905042213",
            "telephone_number": "310-292-8179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAJARDO",
        "first_name": "AN",
        "middle_name": "PHAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-08",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "295871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nadia Faiq
• Rose Katharine Fairbairn, SLP
• Elsa C Fairley, RN
• Marshall James Fairres
• Muhammad Faisal
• Gizell Fajardo
• Miko Francis Fajardo
• Adriel Andrew Fajilan, M.D.
• Fajuz Psychiatry Associates LLC
• Adetoun Fidelia Fakoya

• Physical Therapist in Torrance, CA
• Providers in Torrance, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.