1629494505 NPI number — DR. JILL YUZURIHA FAJARDO O.D.

Table of content: DR. JILL YUZURIHA FAJARDO O.D. (NPI 1629494505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629494505 NPI number — DR. JILL YUZURIHA FAJARDO O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAJARDO
Provider First Name:
JILL
Provider Middle Name:
YUZURIHA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YUZURIHA
Provider Other First Name:
JILL
Provider Other Middle Name:
YOSHIKO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629494505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 EL CAMINO REAL STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94306-1723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3030 ALUM ROCK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95127-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-272-6342
Provider Business Practice Location Address Fax Number:
408-254-5012
Provider Enumeration Date:
03/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  15003TLG , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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