Basic Information
| Provider Information | |||||||||
| NPI: | 1902264302 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAJARDO | ||||||||
| FirstName: | GABRIELA | ||||||||
| MiddleName: | CRISTINA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9015 GARLAND RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752183920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147478800 | ||||||||
| FaxNumber: | 2147478801 | ||||||||
| Practice Location | |||||||||
| Address1: | 9015 GARLAND RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752183920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147478800 | ||||||||
| FaxNumber: | 2147478801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2016 | ||||||||
| LastUpdateDate: | 04/04/2016 | ||||||||
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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 | 363A00000X | PA10442 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.