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General NPI Number Information
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NPI Number | 1497009641
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Entity Type | Organization
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Legal Business Name | PHOENIX OCULOPLASTIC CONSULTANTS, PLLC
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 3410 N 4TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85013-3905
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Country | US
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Telephone | 602-257-1499
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Fax | 480-361-3517
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Provider Business Mailing Address
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Address Line | 4340 E INDIAN SCHOOL RD SUITE 21-440
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City | PHOENIX
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State | AZ
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Zip | 85018-5360
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Country | US
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Telephone | 602-257-1498
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Fax | 480-361-3517
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MISHA FAUSTINA
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Credential | M.D.
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Telephone | 602-257-1498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 33016
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | 33016
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License Number State | AZ
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