Healthcare Provider Details

I. General information

NPI: 1487027231
Provider Name (Legal Business Name): LIZA MARIE FAUGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 GREEN BAY CT
VENTURA CA
93004-2454
US

IV. Provider business mailing address

972 GREEN BAY CT
VENTURA CA
93004-2454
US

V. Phone/Fax

Practice location:
  • Phone: 805-799-7889
  • Fax:
Mailing address:
  • Phone: 805-799-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: