Healthcare Provider Details

I. General information

NPI: 1154312403
Provider Name (Legal Business Name): NATALYA B FAYNBOYM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9165 W THUNDERBIRD RD STE 100
PEORIA AZ
85381-4847
US

IV. Provider business mailing address

13640 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4846
US

V. Phone/Fax

Practice location:
  • Phone: 623-523-6560
  • Fax: 623-523-6581
Mailing address:
  • Phone: 623-876-3800
  • Fax: 623-876-6965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number34352
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2007-00545
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: