1154312403 NPI number — DR. NATALYA B FAYNBOYM MD

Table of content: DR. NATALYA B FAYNBOYM MD (NPI 1154312403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154312403 NPI number — DR. NATALYA B FAYNBOYM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAYNBOYM
Provider First Name:
NATALYA
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154312403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13640 N PLAZA DEL RIO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85381-4846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-876-3800
Provider Business Mailing Address Fax Number:
623-876-6965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9165 W THUNDERBIRD RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-4847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-523-6560
Provider Business Practice Location Address Fax Number:
623-523-6581
Provider Enumeration Date:
11/03/2005

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: 208100000X , with the licence number:  34352 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: 2007-00545 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5907194 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q45007 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1154312403 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 968505 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810009395 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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