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General NPI Number Information
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NPI Number | 1891724886
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Entity Type | Organization
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Legal Business Name | FARO T. OWIESY, M.D., INC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 802 MAGNOLIA AVE SUITE 106
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City | CORONA
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State | CA
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Zip | 92879-3125
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Country | US
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Telephone | 951-371-9500
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Fax | 951-371-9194
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Provider Business Mailing Address
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Address Line | 802 MAGNOLIA AVE SUITE 106
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City | CORONA
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State | CA
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Zip | 92879-3104
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Country | US
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Telephone | 951-371-9500
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Fax | 951-371-9194
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. FARO T. OWIESY
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Credential | M.D
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Telephone | 951-371-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A87796
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License Number State | CA
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