Healthcare Provider Details

I. General information

NPI: 1891724886
Provider Name (Legal Business Name): FARO T. OWIESY, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 MAGNOLIA AVE SUITE 106
CORONA CA
92879-3125
US

IV. Provider business mailing address

802 MAGNOLIA AVE SUITE 106
CORONA CA
92879-3104
US

V. Phone/Fax

Practice location:
  • Phone: 951-371-9500
  • Fax: 951-371-9194
Mailing address:
  • Phone: 951-371-9500
  • Fax: 951-371-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA87796
License Number StateCA

VIII. Authorized Official

Name: DR. FARO T. OWIESY
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 951-371-9500