Etieneth Carolina Fajardo Gomez

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

13921 SW 122ND Ave Apt 303
Miami, FL 33186-6250

Phone

(786) 678-8777

NPI assigned

Apr 2, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1952930059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13921 SW 122ND AVE APT 303",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331866250",
            "telephone_number": "786-678-8777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13921 SW 122ND AVE APT 303",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331866250",
            "telephone_number": "786-678-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAJARDO GOMEZ",
        "first_name": "ETIENETH",
        "middle_name": "CAROLINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-02",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "MIAMI",
            "affiliation": "N",
            "address_1": "13921 SW 122nd Ave Apt 303",
            "city": "Miami",
            "state": "FL",
            "country_code": "US",
            "postal_code": "331866250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Faith Small As a Mustard Seed (Faith As Small As A Mustard Seed)
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• Yovanit Fajardo Aquino, DNM, FNP-BC, ARNP
• Denisse Maria Fajardo Cardoso
• Hailenys Fajardo Guerra
• Alejandro Fajardo Maceo
• Patricia Fajardo Miranda
• Grethel Fajardo Perez, BC BA
• Daniel Fajardo Puerto

• Behavior Technician in Miami, FL
• Providers in Miami, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; 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.