Healthcare Provider Details

I. General information

NPI: 1952570194
Provider Name (Legal Business Name): MISHA FAUSTINA, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010EMCDOWELLRD #406
PHOENIX AZ
85006-2610
US

IV. Provider business mailing address

1010EMCDOWELLRD 406
PHOENIX AZ
85006-2610
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-1499
  • Fax: 602-253-7201
Mailing address:
  • Phone: 602-257-1499
  • Fax: 602-253-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33016
License Number StateAZ

VIII. Authorized Official

Name: DR. MISHA FAUSTINA
Title or Position: OWNER/SURGEON
Credential: MD
Phone: 602-257-1499