Healthcare Provider Details

I. General information

NPI: 1679591663
Provider Name (Legal Business Name): MRS. SUSAN PATRICIA FAUROT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 YORBA LINDA BLVD SUITE 405
YORBA LINDA CA
92886-4056
US

IV. Provider business mailing address

6491 FAIRLYNN BLVD
YORBA LINDA CA
92886-6412
US

V. Phone/Fax

Practice location:
  • Phone: 714-572-1786
  • Fax:
Mailing address:
  • Phone: 714-572-1786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC20800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: