MEDICARE: MR. FAUSTO SAA FNP,BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	735351	TX

General Provider Information

NPI Number	:	1427486711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FAUSTO SAA FNP,BC

Provider Business Mailing Address
First Line	:	21903 ROAN BLF
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2740
Country	:	US
Telephone Number	:	305-335-6542
Fax Number	:

Provider Business Practice Location Address
First Line	:	2827 BABCOCK RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4813
Country	:	US
Telephone Number	:	305-335-6542
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	03/31/2016

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