Provider Demographics
NPI:1679453005
Name:FAJARDO SALAZAR, NARA
Entity type:Individual
Prefix:
First Name:NARA
Middle Name:
Last Name:FAJARDO SALAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16420 SW 137TH AVE APT 125
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2278
Mailing Address - Country:US
Mailing Address - Phone:786-836-3373
Mailing Address - Fax:
Practice Address - Street 1:16420 SW 137TH AVE APT 125
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2278
Practice Address - Country:US
Practice Address - Phone:786-836-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF-610-294-35-900-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty