Basic Information
| Provider Information | |||||||||
| NPI: | 1457828477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAJARDO | ||||||||
| FirstName: | ELISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 NE 14TH ST APT 2609 | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331321630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057100622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4300 ALTON RD | ||||||||
| Address2: | |||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331402948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056742345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2018 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | APRN11000767 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.