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General NPI Number Information
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NPI Number | 1205131513
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Entity Type | Organization
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Legal Business Name | JOHN R FAULKNER MEDICAL DOCTOR PC INC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 72780 COUNTRY CLUB DR # C302
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4126
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Country | US
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Telephone | 760-773-0572
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Fax |
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Provider Business Mailing Address
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Address Line | 72780 COUNTRY CLUB DR # C302
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4126
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Country | US
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Telephone | 760-773-0572
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Fax |
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Authorized Official
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Title or Position | BILLER/OFFICE MANAGER
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Name | MRS. CYNDI MARIE GONZALEZ
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Credential |
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Telephone | 760-773-0572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A70567
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License Number State | CA
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