Provider Demographics
NPI:1003798786
Name:NATASHA A FAJARDO MD PA
Entity type:Organization
Organization Name:NATASHA A FAJARDO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:AILIME
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-338-5020
Mailing Address - Street 1:12555 SW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4725
Mailing Address - Country:US
Mailing Address - Phone:786-338-5020
Mailing Address - Fax:305-894-7400
Practice Address - Street 1:5995 SW 71ST ST STE 403-A
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3531
Practice Address - Country:US
Practice Address - Phone:305-894-7400
Practice Address - Fax:305-894-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty