1023208204 NPI number — MS. CELESTINE LYNN FAETH MS

Table of content: MS. CELESTINE LYNN FAETH MS (NPI 1023208204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023208204 NPI number — MS. CELESTINE LYNN FAETH MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAETH
Provider First Name:
CELESTINE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALFATTI
Provider Other First Name:
CELESTINE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023208204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3663 PACIFIC AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVERMORE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-667-2727
Provider Business Mailing Address Fax Number:
925-449-2684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3663 PACIFIC AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVERMORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-667-2727
Provider Business Practice Location Address Fax Number:
925-449-2684
Provider Enumeration Date:
07/25/2007

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: 106H00000X , with the licence number:  MFC 43722 , 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)