Provider Demographics
NPI:1366905069
Name:FAUCI, RICHARD JAMES
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:FAUCI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 S 1500 E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:UT
Mailing Address - Zip Code:84078-8609
Mailing Address - Country:US
Mailing Address - Phone:480-828-9041
Mailing Address - Fax:
Practice Address - Street 1:826 S 1500 E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:UT
Practice Address - Zip Code:84078-8609
Practice Address - Country:US
Practice Address - Phone:435-781-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7390225X00000X
UT10961164-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist