Provider Demographics
NPI:1215998208
Name:NAZAIRE, FAUSTA (MD)
Entity type:Individual
Prefix:DR
First Name:FAUSTA
Middle Name:
Last Name:NAZAIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12977 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9255
Mailing Address - Country:US
Mailing Address - Phone:561-792-3232
Mailing Address - Fax:561-792-3528
Practice Address - Street 1:12977 SOUTHERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9255
Practice Address - Country:US
Practice Address - Phone:561-792-3232
Practice Address - Fax:561-792-3528
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG58242Medicare UPIN
FL43234ZMedicare ID - Type Unspecified