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NPI Code Detail

MEDICARE: DR. PHILIP ANGELO FARACI M.D.

MEDICARE: DR. PHILIP ANGELO FARACI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician01034774AIN
2208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician036079395IL
3208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianG23163CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
201618941OTHERILBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851391593
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIP ANGELO FARACI M.D.
Provider Business Mailing Address
First Line : 215 W JANSS RD
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-1847
Country : US
Telephone Number : 805-852-9100
Fax Number : 805-852-9101
Provider Business Practice Location Address
First Line : 215 W JANSS RD
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-1847
Country : US
Telephone Number : 805-852-9100
Fax Number : 805-852-9101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 01/18/2022

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