Healthcare Provider Details

I. General information

NPI: 1093681249
Provider Name (Legal Business Name): FARYN TAOTAFA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S HIGLEY RD STE 115
GILBERT AZ
85296-4789
US

IV. Provider business mailing address

43400 N WOLLEMI ST
QUEEN CREEK AZ
85140-3923
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-22580
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-22580
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: