Healthcare Provider Details

I. General information

NPI: 1194630574
Provider Name (Legal Business Name): EMILY LIZBETH FAUSTINO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11425 MOORPARK ST
STUDIO CITY CA
91602-2009
US

IV. Provider business mailing address

5728 CEDROS AVE
VAN NUYS CA
91411-3343
US

V. Phone/Fax

Practice location:
  • Phone: 310-920-8544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: