Healthcare Provider Details

I. General information

NPI: 1700703063
Provider Name (Legal Business Name): ANDREW FAUSTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 BARNEY RD
ANDERSON CA
96007-4301
US

IV. Provider business mailing address

1305 E 50TH ST
LOS ANGELES CA
90011-4217
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-7800
  • Fax: 888-870-9642
Mailing address:
  • Phone: 562-615-3481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: