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General NPI Number Information
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NPI Number | 1164208260
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Entity Type | Individual
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Provider Name | FAUSTINA PREMPEH-COATES
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Gender | Female
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 9548 W AGORA LN
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City | TOLLESON
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State | AZ
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Zip | 85353-4564
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Country | US
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Telephone | 602-930-5974
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Fax | 623-303-1526
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Provider Business Mailing Address
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Address Line | 15827 W MONROE ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-6896
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Country | US
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Telephone | 602-930-5974
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Fax | 623-303-1526
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | DDH3872
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License Number State | AZ
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