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General NPI Number Information
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NPI Number | 1154840304
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Entity Type | Organization
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Legal Business Name | FAUSTINO M. GONZALEZ, MD PC
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 11811 N. TATUM BLVD SUITE 3031
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City | PHOENIX
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State | AZ
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Zip | 85028
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Country | US
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Telephone | 602-529-6422
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Fax | 602-529-6433
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Provider Business Mailing Address
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Address Line | 3309 N 85TH PLACE
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City | SCOTTSDALE
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State | AZ
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Zip | 85251
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Country | US
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Telephone | 602-529-6422
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Fax | 602-529-6433
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. FAUSTINO M GONZALEZ
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Credential | MD
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Telephone | 602-529-6422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 23659
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License Number State | AZ
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